Endocrine Pathology

, Volume 3, Issue 4, pp 173–181 | Cite as

Fine needle aspiration biopsy of the adrenal gland: Cytological features and clinical applications

  • Kenneth C. Suen
  • Norman H. Chan
Original Article
  • 51 Downloads

Abstract

The ability to visualize the adrenal glands with modern imaging techniques has improved our detection of small adrenal masses. In cancer patients, metastatic tumors to the adrenal glands are common, but not all adrenal masses are metastases. Percutaneous fine needle aspiration biopsy can be used in distinguishing metastatic malignancies to the adrenal glands from primary adrenal lesions. In our series we achieved a success rate of 86% in obtaining cellular material for diagnosis. A diagnosis of metastatic malignancy obviates the need for surgical intervention and is essential for staging and therapeutic planning. Primary adrenal cortical masses with benign cytology and under 5 cm in size can be managed conservatively with follow-up scans; those with atypical cytology or greater than 5 cm in size warrant surgical exploration. Adrenalectomy is the treatment of choice for any adrenal tumor associated with endocrine abnormality, irrespective of tumor size and cytology.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Abrams HL. Metastases in carcinoma: Analysis of 1000 autopsied cases. Cancer 3:74–85, 1950.PubMedCrossRefGoogle Scholar
  2. 2.
    Belldegrun A, Hussain S, Seltzer SE, Loughlin KR, Gittes RF, Richie JP. Incidentally discovered mass of the adrenal gland. Surg Gynecol Obstet 163:203–208, 1986.PubMedGoogle Scholar
  3. 3.
    Berkman WA, Bernardino ME, Sewell CW, Price RB, Sones PJ Jr. The computed tomography-guided adrenal biopsy. An alternative to surgery in adrenal mass diagnosis. Cancer 53:2098–2103, 1984.PubMedCrossRefGoogle Scholar
  4. 4.
    Bernardino ME, Walther CM, Phillips VM, Graham SD Jr, Sewell CW. CT-guided adrenal biopsy: Accuracy, safety and indications. Am J Roentgenol 144:67, 1985.Google Scholar
  5. 5.
    Bullock WK, Hirst AE. Metastatic carcinoma of the adrenal glands. Am J Med Sci 266: 521–524, 1953.CrossRefGoogle Scholar
  6. 6.
    Cote RJ, Cordon-Cardo C, Reuter VE, Rosen PP. Immunopathology of adrenal and renal cortical tumors. Am J Pathol 136:1077–1084, 1990.PubMedGoogle Scholar
  7. 7.
    Gandour MJ, Grizzle WE. A small adrenocortical carcinoma with aggressive behavior. Arch Pathol Lab Med 110:1076–1079, 1986.PubMedGoogle Scholar
  8. 8.
    Gaffey MJ, Traweek ST, Mills SE, et al. Cytokeratin expression in adrenocortical neoplasia. Hum Pathol 23:144–153, 1992.PubMedCrossRefGoogle Scholar
  9. 9.
    Heaston DK, Handel DB, Ashton PR, Korobkin M. Narrow gauge needle aspiration of solid adrenal masses. AJR 138:1143–1148, 1982.PubMedGoogle Scholar
  10. 10.
    Incze JS, Lui PS, Merriam JC, et al. Morphology and pathogenesis of adrenal cysts. Am J Pathol 95:423–428, 1979.PubMedGoogle Scholar
  11. 11.
    Katsuta K, Nakabayashi H, Kuroda Y, Liu PI. Adrenal myelolipoma: Preoperative diagnosis by fine needle aspiration cytology. Diagn Cytopathol 5:298–300, 1989.PubMedCrossRefGoogle Scholar
  12. 12.
    Katz RL, Patel S, Mackay B, Zornoza J. Fine needle aspiration cytology of the adrenal gland. Acta Cytol 28:269–282, 1984.PubMedGoogle Scholar
  13. 13.
    Katz RL, Shirkhoda A. Diagnostic approach to incidental adrenal nodules in the cancer patient. Cancer 55:1995–2000, 1985.PubMedCrossRefGoogle Scholar
  14. 14.
    Khafagi FA, Gross MD, Shapiro B, Glazer GM, Francis I, Thompson NW. Clinical significance of the large adrenal mass. Br J Surg 78:828–833, 1991.PubMedCrossRefGoogle Scholar
  15. 15.
    King DR, Lack EE. Adrenal cortical carcinoma. A clinical and pathologic study of 49 cases. Cancer 44:239–244, 1979.PubMedCrossRefGoogle Scholar
  16. 16.
    Levin NP. Fine needle aspiration and histology of adrenal cortical carcinoma: A case report. Acta Cytol 25:421–424, 1981.PubMedGoogle Scholar
  17. 17.
    McCorkell SJ, Niles NL. Fine needle aspiration of catecholamine-producing adrenal masses: A possibly fatal mistake. AJR 145:113–114, 1985.PubMedGoogle Scholar
  18. 18.
    Miettinen M, Lehto V, Virtanen I. Immunofluorescence microscopic evaluation of the intermediate filament expression of the adrenal cortex and medulla and their tumors. Am J Pathol 118:360–366, 1985.PubMedGoogle Scholar
  19. 19.
    Min KW, Song J, Boesenberg M, Acebey J. Adrenal cortical nodule mimicking small round cell malignancy on fine needle aspiration. Acta Cytol 32:543–546, 1988.PubMedGoogle Scholar
  20. 20.
    Mitchell ML, Ryan FP Jr, Shermer RW. Pulmonary adenocarcinoma metastatic to the adrenal gland mimicking normal adrenal cortical epithelium on fine needle aspiration. Acta Cytol 29:994–998, 1985.PubMedGoogle Scholar
  21. 21.
    Mitnick JS, Bosniak MA, Megibow AJ, Naidich DP. Non-functioning adrenal adenomas discovered incidentally on computed tomography. Radiology 148:495–499, 1983.PubMedGoogle Scholar
  22. 22.
    Montali G, Solbiati L, Bossi MC, De Pra L, Di Donna A, Ravetto C. Sonographically guided fine needle aspiration biopsy of adrenal masses. AJR 143:1081–1084, 1984.PubMedGoogle Scholar
  23. 23.
    Moussouris HF, Koss LG, Rosenblatt R, Kutcher R. Thin needle aspiration biopsy of abdominal organs. In: Koss LG, Coleman DV, eds. Advances in clinical cytology, vol 2. New York: Masson Publishing, 1984. Pp 226–228.Google Scholar
  24. 24.
    Nguyen GK. Cytopathologic aspects of adrenal pheochromocytoma in a fine needle aspiration biopsy. Acta Cytol 26:354–358, 1982.PubMedGoogle Scholar
  25. 25.
    O’Leary TJ, Ooi TC. The adrenal incidentaloma. Can J Surg 29:6–8, 1986.PubMedGoogle Scholar
  26. 26.
    Phillips JG, Orr JWJr, Grizzle W, Hatch KD, Shingleton HM. An extra-adrenal pheochromocytoma mimicking lymphnode metastasis from a cervical cancer. Gynecol Oncol 13: 416–420, 1982.PubMedCrossRefGoogle Scholar
  27. 27.
    Saboorian H, Katz R, Boyd D, Charnsangavej C. Fine needle aspiration cytology of primary and metastatic lesions of adrenal gland [Abstr]. Mod Pathol 5:28A, 1992.Google Scholar
  28. 28.
    Schwartz RW, Sloan DA, Kenady DE. Diagnosis and treatment of primary adrenal tumors. Curr Opin Oncol 3:121–127, 1991.PubMedCrossRefGoogle Scholar
  29. 29.
    Shagian-Edwards A, Holland JF. Metastatic carcinoma to the adrenal glands with cortical hypofunction. Cancer 7:1242–1248, 1954.CrossRefGoogle Scholar
  30. 30.
    Silverman JF, Dabbs DJ, Ganick DJ, Holbrook CT, Geisinger KR. Fine needle aspiration cytology of neuroblastoma, including peripheral neuroectodermal tumor, with immunocytochemical and ultrastructural confirmation. Acta Cytol 32:367–376, 1988.PubMedGoogle Scholar
  31. 31.
    Suen KC. Retroperitoneum and intestine. Guides to clinical aspiration biopsy. New York: Igaku-Shoin, 1987. Pp 165–189.Google Scholar
  32. 32.
    Suen KC. Adrenal cortical cells mimicking small cell anaplastic carcinoma in a fine needle aspirate. Mod Pathol 4:594–595, 1991.PubMedGoogle Scholar
  33. 33.
    Suzuki T, Sasano H, Nisikawa T, Rhame J, Wilkinson DS, Nagura H. Discerning malignancy in human adrenocortical neoplasms: Utility of DNA flow cytometry and immunohistochemistry. Mod Pathol 5:224–231, 1992.PubMedGoogle Scholar
  34. 34.
    Varma S, Amy RW. Adrenal cortical carcinoma metastatic to the lung: Report of a case diagnosed by fine needle aspiration biopsy. Acta Cytol 34:104–105, 1990.PubMedGoogle Scholar
  35. 35.
    Weiss LM. Comparative histologic study of 43 metastasizing and nonmetastasizing adrenocortical tumors. Am J Surg Pathol 8:163–169, 1984.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 1992

Authors and Affiliations

  • Kenneth C. Suen
    • 1
  • Norman H. Chan
    • 2
  1. 1.Department of PathologyVancouver General HospitalVancouverCanada
  2. 2.St. Paul’s Hospital (NHC)University of British ColumbiaVancouverCanada

Personalised recommendations