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

• Puri R
• Thandassery RB
• Choudhary
• Kotecha H
• Misra SR
• Bhagat S
• Paliwal M
• Madan K
• Saraf N
• Sarin H
• Guleria M
• Sud R

• KMID: 1801209
• DOI: http://doi.org/10.5946/ce.2015.48.2.165

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).

Reference

1. Vilmann P, Jacobsen GK, Henriksen FW, Hancke S. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc. 1992; 38:172–173. PMID: 1568614.

2. Jhala NC, Jhala DN, Chhieng DC, Eloubeidi MA, Eltoum IA. Endoscopic ultrasound-guided fine-needle aspiration. A cytopathologist's perspective. Am J Clin Pathol. 2003; 120:351–367. PMID: 14502798.

3. Jhala D, Eloubeidi M, Chhieng DC, et al. Fine needle aspiration biopsy of the islet cell tumor of pancreas: a comparison between computerized axial tomography and endoscopic ultrasound-guided fine needle aspiration biopsy. Ann Diagn Pathol. 2002; 6:106–112. PMID: 12004358.

4. Eloubeidi MA, Seewald S, Tamhane A, et al. EUS-guided FNA of the left adrenal gland in patients with thoracic or GI malignancies. Gastrointest Endosc. 2004; 59:627–633. PMID: 15114304.

5. DeWitt J, Alsatie M, LeBlanc J, McHenry L, Sherman S. Endoscopic ultrasound-guided fine-needle aspiration of left adrenal gland masses. Endoscopy. 2007; 39:65–71. PMID: 17252463.

6. Dietrich CF, Wehrmann T, Hoffmann C, Herrmann G, Caspary WF, Seifert H. Detection of the adrenal glands by endoscopic or transabdominal ultrasound. Endoscopy. 1997; 29:859–864. PMID: 9476771.

7. Eloubeidi MA, Morgan DE, Cerfolio RJ, Eltoum IA. Transduodenal EUS-guided FNA of the right adrenal gland. Gastrointest Endosc. 2008; 67:522–527. PMID: 18234198.

8. Mody MK, Kazerooni EA, Korobkin M. Percutaneous CT-guided biopsy of adrenal masses: immediate and delayed complications. J Comput Assist Tomogr. 1995; 19:434–439. PMID: 7790554.

9. Welch TJ, Sheedy PF 2nd, Johnson CD, Johnson CM, Stephens DH. CT-guided biopsy: prospective analysis of 1,000 procedures. Radiology. 1989; 171:493–496. PMID: 2704815.

10. Puri R, Thandassery RB, Eloubeidi MA, Sud R. Diagnosis of isolated pancreatic tuberculosis: the role of EUS-guided FNA cytology. Gastrointest Endosc. 2012; 75:900–904. PMID: 22440205.

11. Welch TJ, Sheedy PF 2nd, Stephens DH, Johnson CM, Swensen SJ. Percutaneous adrenal biopsy: review of a 10-year experience. Radiology. 1994; 193:341–344. PMID: 7972740.

12. Bodtger U, Vilmann P, Clementsen P, Galvis E, Bach K, Skov BG. Clinical impact of endoscopic ultrasound-fine needle aspiration of left adrenal masses in established or suspected lung cancer. J Thorac Oncol. 2009; 4:1485–1489. PMID: 19752760.

13. Schuurbiers OC, Tournoy KG, Schoppers HJ, et al. EUS-FNA for the detection of left adrenal metastasis in patients with lung cancer. Lung Cancer. 2011; 73:310–315. PMID: 21277038.

14. Eloubeidi MA, Black KR, Tamhane A, Eltoum IA, Bryant A, Cerfolio RJ. A large single-center experience of EUS-guided FNA of the left and right adrenal glands: diagnostic utility and impact on patient management. Gastrointest Endosc. 2010; 71:745–753. PMID: 20156622.

15. Jhala NC, Jhala D, Eloubeidi MA, et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy of the adrenal glands: analysis of 24 patients. Cancer. 2004; 102:308–314. PMID: 15376200.

16. Uemura S, Yasuda I, Kato T, et al. Preoperative routine evaluation of bilateral adrenal glands by endoscopic ultrasound and fine-needle aspiration in patients with potentially resectable lung cancer. Endoscopy. 2013; 45:195–201. PMID: 23299524.