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
