Adrenal gland & paraganglia
Other nonneoplastic
Cysts (endothelial, pseudocyst, parasitic)


Topic Completed: 31 March 2020

Minor changes: 31 March 2020

Copyright: 2002-2020, PathologyOutlines.com, Inc.

PubMed Search: Cysts [title] adrenal


Lan L. Gellert, M.D., Ph.D.
Debra Zynger, M.D.
Page views in 2019: 3,036
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Cite this page: Gellert LL, Zynger D. Cysts (endothelial, pseudocyst, parasitic) . PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/adrenalcysts.html. Accessed August 8th, 2020.
Definition / general
  • Mostly incidental finding on imaging studies
  • Endothelial (vascular) cyst is most common type and are nonneoplastic
  • Most are nonfunctional
Essential features
  • Types include endothelial (45%), pseudocysts (39%), epithelial (9%) and parasitic (7%) (World J Surg 2004;28:97)
  • Most are nonfunctional
Epidemiology
  • Incidence of 0.06% in surgical series and 0.18% at autopsy (Radiology 1996;201:541)
  • Commonly present in fourth or fifth decade
  • Mostly women
Clinical features
  • May produce mass or flank pain
Etiology
  • Endothelial (vascular) cyst
    • Thought to be dilated and thrombosed vessels with organization
    • Nonneoplastic thus using the term “hemangioma” or “lymphangioma” is not recommended
  • Pseudocyst
  • Parasitic cyst
    • Usually caused by Echinococcus granulosus larva, as part of disseminated hydatid disease
    • Rarely caused by visceral leishmaniasis
Radiology images

Images hosted on other servers:

Endothelial cyst

Hydatid cyst


Pseudocyst

Case reports
Treatment
  • Observation
  • Percutaneous drainage
  • Enucleation
  • Adrenalectomy
  • Anthelmintic agents
Gross description
  • Up to 30 cm, usually unilateral with irregular thick fibrous wall and calcifications
  • Often yellow, residual adrenocortical tissue in cystic wall
Gross images

Contributed by Debra Zynger, M.D.

Hemorrhagic
pseudocyst



Images hosted on other servers:
Missing Image

Endothelial cyst

Pseudocyst

Hydatid cyst

Microscopic (histologic) description
  • Endothelial (vascular) cyst
    • Usually multilocular
    • Cystic wall lined by flattened endothelial cells
    • Hemorrhage, hemosiderin and calcification common
  • Pseudocyst
    • Fibrous cystic wall with no endothelial or epithelial lining
    • Hemorrhage and hemosiderin common
  • Parasitic cyst
    • Wall and cyst contains eosinophils
    • Evidence of calcified parasite within cyst
Microscopic (histologic) images

Contributed by Debra Zynger, M.D.

Endothelial cyst



Contributed by Lan L. Gellert, M.D., Ph.D.
Missing Image

Hydatid cyst



Images hosted on other servers:

Pseudocyst

Cytology images

Images hosted on other servers:

Hydatid cyst

Positive stains
Differential diagnosis
Board review style question #1
Which of the following is the most common cause of adrenal parasitic cysts?

  1. Echinococcus
  2. Leishmania
  3. Strongyloides
  4. Taenia solium
  5. Toxoplasma
Board review answer #1
A. Echinococcus. Most adrenal parasitic cysts are caused by Echinococcus granulosus larva. Infection by the larvae of Taenia solium causes cysts in the muscle or brain (called cysticercosis)

Reference: Cysts (endothelial, pseudocyst, parasitic)

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