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Hormones

, Volume 14, Issue 1, pp 47–58 | Cite as

Surgical treatment of potentially primary malignant adrenal tumors: an unresolved issue

  • George N. Zografos
  • Iraklis Perysinakis
  • Eustathia Kyrodimou
  • Eva Kassi
  • Gregory Kaltsas
Review

Abstract

Although the great majority of incidentalomas are adrenocortical adenomas, a number of them, depending on the size and radiological characteristics of the lesions, will turn out to be carcinomas. These tumors may present as suspicious on initial evaluation and potentially malignant or malignant on histology. Adrenocortical carcinoma is a rare and aggressive malignancy with evolving diagnostic and therapeutic approaches. Laparoscopic surgery has become the gold standard for surgery of benign adrenal tumors. Despite the extensive experience gained in laparoscopic adrenalectomy, controversy still remains in the management of adrenal tumors with high suspicion or evidence of malignancy. The aim of this review is to update the existing information regarding the diagnostic approach and surgical management of suspicious and potentially malignant primary adrenal tumors. The interpretation of radiologic characteristics is a cornerstone in pre-operative assessment of large adrenal masses, since open surgery remains the preferred procedure when malignancy is suspected in large tumors with possible local invasion. Despite the improvement of imaging techniques, they lack sufficient accuracy to exclude primary malignancy in tumors from 4 cm to 10 cm in size. An initial laparoscopic approach can be used in this group of patients, but early conversion to open technique is mandatory if curative resection cannot be performed. Adrenal tumors >10 cm of malignant potential should be treated by the open approach from the start. Solitary adrenal metastasis from another primary malignancy is usually amenable to laparoscopic surgery. Patients with suspected adrenal cancer should be referred to tertiary centers that perform laparoscopic and open adrenal surgery with minimal morbidity and mortality.

Key words

Adrenal carcinoma Laparoscopic adrenalectomy Potentially malignant Treatment 

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Copyright information

© Hellenic Endocrine Society 2015

Authors and Affiliations

  • George N. Zografos
    • 1
  • Iraklis Perysinakis
    • 1
  • Eustathia Kyrodimou
    • 2
  • Eva Kassi
    • 3
  • Gregory Kaltsas
    • 4
  1. 1.Third Department of SurgeryGeneral Hospital “G. Gennimatas”AthensGreece
  2. 2.Pathology DepartmentGeneral Hospital “G. Gennimatas”AthensGreece
  3. 3.Department of BiochemistryNational University of AthensAthensGreece
  4. 4.Department of PathophysiologyNational University of AthensAthensGreece

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