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THE ADRENALECTOMY IN RARE ENDOCRINE TUMORS – 2 CASES REPORT

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Author(s): Catalina Poiană | Mara Carsote | Rene Baloescu | Bogdan Stanescu | Razvan Petrescu | Cornelia Corneci | Dan Hortopan | Corina Chirita | Dumitru Ioachim | Dana Terzea

Journal: Jurnalul de Chirurgie
ISSN 1584-9341

Volume: 6;
Issue: 1;
Start page: 47;
Date: 2010;
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Keywords: ADRENALECTOMY | LAPAROSCOPY | ADRENAL TUMOR

ABSTRACT
Adrenal tumors are a rare finding. The endocrine profile is complex. The adrenalectomy is a major step in their therapy but it also brings out major information regarding the possible aggressive profile based on pathological exam and immuno-hystological findings. We present two cases cured by surgical procedure that also provided material for elucidating the diagnosis. Case 1 is 58-year-old female with metabolic syndrome. She is incidentally diagnosed by a routine abdominal ultrasound with a left adrenal mass. This apparently doubled the size in only 3 months, up to 9.3 by 8.5 cm, as pointed by the computed tomography scan, suggesting an adrenal carcinoma. The laparoscopic left adrenalectomy was performed and the pathological report revealed an adrenal adenoma with osteoid metaplasia, a rare finding is such tumors. The evolution after surgery was good. The prognostic was better that seemed initially before. Case 2 is a 50-year-old female patient presenting progressive hirsutism. The investigations suggested an adrenal carcinoma, based on: very high serum testosterone levels (5 times above normal) and 24-hours urinary ketosteroids (5 times as normal). The computed tomography showed a right adrenal tumor of 11.5 by 11 by 12 cm. Because of these findings, a carcinoma was suspected and right open adrenalectomy was performed. The pathological report showed that the tumor was gigantic, up to 14 cm, with a weight of 780 g. The structure was complex: trabecular and compact zones, anisocytosis, anisocaryosis, hemorrhage, calcar impregnations, osteoid metaplasia. No invasion into the capsule or the vessels was found. The immuno-hystochemistry showed positive reaction for melan A, vimentin, and synaptophisin. For the moment, no therapy is necessary. Further follow up by serum endocrine markers and serial imagistic scan are necessary. Both cases are suggestive for the importance of adrenalectomy in the cure of adrenal tumors.
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