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CC BY-NC-ND 4.0 · J Lab Physicians 2022; 14(03): 231-236
DOI: 10.1055/s-0041-1741441
Original Article

Spectrum of Adrenal Lesions on Fine-Needle Aspiration Cytology: A Tertiary Care Centre Experience

Pavneet Kaur
1   Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
,
Ankita Soni
1   Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
,
Ruchita Tyagi
1   Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
,
Harpreet Kaur
1   Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
,
Kanwarpal S. Selhi
1   Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
› Author Affiliations Funding None.
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Abstract

Introduction Fine-needle aspiration cytology (FNAC) is an easy, quick, and specialized technique to distinguish neoplastic from non-neoplastic adrenal lesions, yet limited to tertiary care centers. It helps in analyzing symptomatic, as well as incidental adrenal lesions with high sensitivity and specificity.

Aim This study was conducted to determine the cytological spectrum of adrenal lesions in a tertiary care center.

Material and Methods This was a retrospective study which included a total of 19 cases of adrenal FNAC received from June 2017 till June 2019 in a north Indian tertiary care university hospital. All the lesions were broadly classified into non-neoplastic and neoplastic categories. The non-neoplastic lesions were divided into infective causes and cystic lesions. Neoplastic lesions were further grouped into benign and malignant lesions. Immunohistochemical findings were retrieved from the hospital records wherever accessible.

Results A total of 19 cases were aspirated, of which 16 cases (84.20%) yielded satisfactory material. Six cases (31.57%) showed non-neoplastic pathology of which one was a cystic lesion, three were infective (two histoplasmosis and one tuberculosis), and two showed only benign adrenal cortical cells in a setting of known extra-adrenal primary malignancy. The neoplastic group comprised of 10 cases (52.63%) of which 4 cases showed metastatic carcinomatous deposits from a known extra-adrenal primary malignancy and 6 cases showed primary adrenal neoplasm (one case of myelolipoma, one case of pheochromocytoma, and four cases of adrenal neoplasm) which were then subjected to biopsy and immunohistochemistry. A final diagnosis of pheochromocytoma was made in three cases, adrenocortical carcinoma in one case, and one case was inconclusive because of nonrepresentative biopsy.

Conclusion Image-guided fine-needle aspiration cytology of adrenal lesions helps to determine the exact nature of the infection, avoids unnecessary surgery, and helps in targeted management. However, histopathological evaluation with immunohistochemistry remains the diagnostic modality of choice with regard to neoplastic lesions.

Keywords

adrenal neoplasm - cytology - immunohistochemistry


Publication History

Article published online:
18 January 2022

© 2022. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Rana C, Krishnani N, Kumari N. Spectrum of adrenal lesions on fine needle aspiration cytology. Indian J Pathol Microbiol 2012; 55 (04) 461-466
    CrossrefPubMedGoogle Scholar
  • 2 Ren R, Guo M, Sneige N, Moran CA, Gong Y. Fine-needle aspiration of adrenal cortical carcinoma: cytologic spectrum and diagnostic challenges. Am J Clin Pathol 2006; 126 (03) 389-398
    CrossrefPubMedGoogle Scholar
  • 3 Lumachi F, Borsato S, Brandes AA. et al. Fine-needle aspiration cytology of adrenal masses in noncancer patients: clinicoradiologic and histologic correlations in functioning and nonfunctioning tumors. Cancer 2001; 93 (05) 323-329
    CrossrefPubMedGoogle Scholar
  • 4 Tirabassi G, Kola B, Ferretti M. et al. Fine-needle aspiration cytology of adrenal masses: a re-assessment with histological confirmation. J Endocrinol Invest 2012; 35 (06) 590-594
    PubMedGoogle Scholar
  • 5 Moreira Jr. SG, Pow-Sang JM. Evaluation and management of adrenal masses. Cancer Contr 2002; 9 (04) 326-334
    CrossrefPubMedGoogle Scholar
  • 6 Mantero F, Arnaldi G. Investigation protocol: adrenal enlargement. Clin Endocrinol (Oxf) 1999; 50 (02) 141-146
    CrossrefPubMedGoogle Scholar
  • 7 Kini JR, Gautam K, Augustine A. Adrenal gland cyst: a diagnostic conundrum: report of a case with review of literature. J Med Soc 2014; 28: 123-124
    CrossrefGoogle Scholar
  • 8 Al-Mamari A, Balkhair A, Gujjar A. et al. A case of disseminated tuberculosis with adrenal insufficiency. Sultan Qaboos Univ Med J 2009; 9 (03) 324-327
    PubMedGoogle Scholar
  • 9 Kumar R, Dey P. Fine-needle aspiration cytology of non-neoplastic adrenal pathology. Diagn Cytopathol 2016; 44 (06) 472-476
    CrossrefPubMedGoogle Scholar
  • 10 Kapatia G, Saha A, Rohilla M. et al. Clinical and morphological spectrum of histoplasmosis on cytology along with the review of literature. Acta Cytol 2020; 64 (06) 532-538
    CrossrefPubMedGoogle Scholar
  • 11 Puri S, Mardi K, Gupta N, Rao M. Adrenal incidentalomas with review of literature. J Cytol Histol 2016; 7: 426
    CrossrefGoogle Scholar
  • 12 Katsuta K, Nakabayashi H, Kuroda Y, Liu PI. Adrenal myelolipoma: preoperative diagnosis by fine-needle aspiration cytology. Diagn Cytopathol 1989; 5 (03) 298-300
    CrossrefPubMedGoogle Scholar
  • 13 Katz RL, Shirkhoda A. Diagnostic approach to incidental adrenal nodules in the cancer patient. Results of a clinical, radiologic, and fine-needle aspiration study. Cancer 1985; 55 (09) 1995-2000
    CrossrefPubMedGoogle Scholar
  • 14 Welch TJ, Sheedy II PF, Stephens DH, Johnson CM, Swensen SJ. Percutaneous adrenal biopsy: review of a 10-year experience. Radiology 1994; 193 (02) 341-344
    CrossrefPubMedGoogle Scholar
  • 15 Karre S, Gorva A, Shanmugam C, Gorrela VDPK, Veeragandham S. Histopathologic spectrum of adrenal lesions. Ind J Pathol Oncol 2018; 5: 463-469
    Google Scholar
  • 16 Proye CAG, Pattou FN. Adrenocortical carcinoma. Nonfunctioning and functioning. In: Clark OH, Duh Q-Y. eds. Textbook of Endocrine Surgery. Philadelphia, PA: WB Saunders; 1997: 490-496
    Google Scholar
  • 17 Jiménez-Heffernan JA, Vicandi B, López-Ferrer P, González-Peramato P, Pérez-Campos A, Viguer JM. Cytologic features of pheochromocytoma and retroperitoneal paraganglioma: a morphologic and immunohistochemical study of 13 cases. Acta Cytol 2006; 50 (04) 372-378
    CrossrefPubMedGoogle Scholar