From Adenoma to Carcinoma: The Unexpected Evolution of an Apparent- ly Stable Adrenal Lesion
Giacomo Cristofolini1,2,*, Giulia Maida1,2, Simona Jaafar1,2, Stella Pigni1,2, Erika M. Grossrubatscher3, Benedetta Zampetti3, Gherardo Mazziotti1,2, Andrea Lania1,2, Paolo Dalino Ciaramella3 and Iacopo Chiodini3,4
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Milan, Italy; 2 Endocrinology, Dia- betology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy; 3Endocrine Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; 4Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122, Milan, Italy
Abstract: Background: There is a lack of solid long-term evidence with respect to the management over time of adrenal incidenta- lomas that miss clearly benign radiological features. We present the case of a 75-year-old man with a non-secreting adrenal mass, apparently stable in size (14 mm) and unchanged in features for 2 years, but subsequently diagnosed as adrenal carcinoma.
Case Report: The patient was referred to Grande Ospedale Metropolitano Niguarda in August 2022 due to the presence of a large lesion in the left adrenal site. In 2017, a 14 mm, 20 HU, round, regular-edged lesion was detected at a CT scan without contrast me- dium. Over the next two years, the patient was re-evaluated every 6 months with follow-up CT scans with no apparent densitometric or dimensional changes in the known lesion. In September 2022, 3 years after the last CT scan, the patient was hospitalised for pneumonia. An abdominal CT scan acquired during the hospitalisation showed an increase of the lesion to 14.5x10x12 cm. The pa- tient subsequently underwent open nephrosurrenectomy, and histological examination confirmed the presence of an adrenal carcino- ma (proliferation index 5%, Weiss score 7). No adjuvant therapy was administered, and the last CT scan in December 2022 was neg- ative for the recurrence of the disease.
Conclusion: Adrenal carcinoma usually presents as a clearly malignant lesion with rapid growth and a marked tendency to metasta- sise. This case highlights how an adrenal adenoma with indeterminate features is worthy of follow-up over time despite its apparent dimensional and radiological stability [1].
*Address correspondence to this author at the Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Milan, Italy; Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy; E-mail: giacomo.cristofolini@humanitas.it
REFERENCE
[1] Fassnacht, M .; Tsagarakis, S .; Terzolo, M .; Tabarin, A .; Sahdev, A .; Newell-Price, J .; Pelsma, I .; Marina, L .; Lorenz, K .; Bancos, I .; Arlt, W .; Dekkers, O.M. European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors. Eur. J. Endocrinol., 2023, 189(1), G1-G42. http://dx.doi.org/10.1093/ejendo/lvad066 PMID: 37318239