Clin Endosc.  2015 Mar;48(2):165-170. 10.5946/ce.2015.48.2.165.

Endoscopic Ultrasound-Guided Fine-Needle Aspiration of the Adrenal Glands: Analysis of 21 Patients

Affiliations
  • 1Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India. doc.ragesh@gmail.com
  • 2Department of Cytopathology, Medanta The Medicity, Gurgaon, India.

Abstract

BACKGROUND/AIMS
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology of adrenal masses helps in etiological diagnosis. The aim of this study was to evaluate the diagnostic yield of EUS-FNA of adrenal masses in cases where other imaging methods failed and/or were not feasible.
METHODS
Twenty-one consecutive patients with adrenal masses, in whom adrenal FNA was performed because conventional imaging modalities failed and/or were not feasible, were prospectively evaluated over a period of 3 years.
RESULTS
Of the 21 patients (mean age, 56+/-12.2 years; male:female ratio, 2:1), 12 had pyrexia of unknown origin and the other nine underwent evaluation for metastasis. The median lesion size was 2.4x1.6 cm. Ten patients were diagnosed with tuberculosis (shown by the presence of caseating granulomas [n=10] and acid-fast bacilli [n=4]). Two patients had EUS-FNA results suggestive of histoplasmosis. The other patients had metastatic lung carcinoma (n=6), hepatocellular carcinoma (n=1), and adrenal lipoma (n=1) and adrenal myelolipoma (n=1). EUS results were not suggestive of any particular etiology. No procedure-related adverse events occurred.
CONCLUSIONS
EUS-FNA is a safe and effective method for evaluating adrenal masses, and it yields diagnosis in cases where tissue diagnosis is impossible or has failed using conventional imaging modalities.

Keyword

Adrenal mass; Endosonography; Fine-needle aspiration cytology; Tuberculosis

MeSH Terms

Adrenal Glands*
Biopsy, Fine-Needle*
Carcinoma, Hepatocellular
Diagnosis
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Endosonography
Fever
Granuloma
Histoplasmosis
Humans
Lipoma
Lung
Myelolipoma
Neoplasm Metastasis
Prospective Studies
Tuberculosis

Figure

  • Fig. 1 Fine-needle aspiration cytology images of different adrenal gland lesions. (A) Periodic acid-Schiff staining displaying many intracellular and extracellular yeastcells (histoplasma capsulatum, ×40). (B) Granulomatous inflammation with caseous necrosis (Giemsa, ×20). (C) Metastatic hepatocellular carcinoma, polygonal cells with macronuclei and abundant cytoplasm showing bile (Giemsa, ×40). (D) Megakaryocytes, plasma cells, and erythroid series (Giemsa, ×40).

  • Fig. 2 Endosonographic appearance of adrenal lesions. (A) Right adrenal lesion (tuberculosis [TB]). (B) Fine-needle aspiration (FNA) of right adrenal lesion (TB). (C) FNA of right adrenal lesion (lipoma). (D) Left adrenal myelolipoma. (E) Left adrenal histoplasmosis. (F) FNA of left adrenal lesion (pancreatic carcinoma) with an adjacent celiac axis lymph node (asterisk).


Cited by  1 articles

Is Endoscopic Ultrasonography-Guided Fine Needle Aspiration Trailblazing in Tissue Sampling of Adrenal Masses?
Tae Hyeon Kim
Clin Endosc. 2015;48(2):94-95.    doi: 10.5946/ce.2015.48.2.94.


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