Adrenal gland & paraganglia

Other nonneoplastic

Cysts



Last author update: 20 February 2024
Last staff update: 6 March 2024

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PubMed Search: Adrenal cysts

Jacob Anthuvan, B.S.
Debra L. Zynger, M.D.
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Cite this page: Anthuvan J, Zynger DL. Cysts. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/adrenalcysts.html. Accessed March 29th, 2024.
Definition / general
Essential features
Epidemiology
Sites
Pathophysiology
Clinical features
Diagnosis
  • Typically incidental finding on radiology imaging, which is then further evaluated via hormonal analysis (Eur J Endocrinol 2022;187:429)
  • Fine needle aspiration (FNA) may be utilized to characterize the lesion
  • Approximately half undergo surgical resection with histopathologic microscopic examination (Eur J Endocrinol 2022;187:429)
  • Definitive diagnosis and cyst subtyping is made by microscopic examination of tissue
Laboratory
  • Most adrenal cysts are hormonally nonfunctional
  • It is important to rule out a functional cystic tumor through adrenal hormone testing
  • Proposed testing regimen involves evaluation of serum potassium and aldosterone, dexamethasone suppression test, dehydroepiandrosterone sulfate (DHEA-S) and 24 hour urine metanephrines (Curr Urol Rep 2010;11:44)
  • Some cases of adrenal cysts with adrenal hormone excess have been described in the literature but may be secondary to hemorrhage into adrenal adenoma and their true prevalence is debatable (Eur J Endocrinol 2022;187:429, Nat Rev Endocrinol 2023;19:398)
Radiology description

Endothelial cysts
Pseudocysts
Epithelial cysts
Parasitic cysts
Radiology images

Images hosted on other servers:
Giant endothelial cyst Giant endothelial cyst

Giant endothelial cyst

Giant pseudocyst

Giant pseudocyst

Hydatid cyst

Hydatid cyst

Prognostic factors
Case reports
Treatment
Clinical images

Images hosted on other servers:
Pseudocyst Pseudocyst

Pseudocyst

Hydatid cyst Hydatid cyst

Hydatid cyst

Gross description
Gross images

Contributed by Debra L. Zynger, M.D.
Endothelial cyst with clot

Endothelial cyst with clot

Endothelial cyst with minimal blood

Endothelial cyst with minimal blood

Pseudocyst reclassified as endothelial cyst

Pseudocyst reclassified as endothelial cyst

Pseudocyst

Pseudocyst

Microscopic (histologic) description
  • Endothelial cysts
    • Cyst lining of flattened, bland endothelium
    • Endothelial lining may be difficult to visualize
    • Cyst wall and contents of hemorrhage, debris and calcification
    • Revascularization and papillary endothelial hyperplasia often present
  • Pseudocysts
    • No cyst lining is present; careful search for intact lining may reveal endothelium, reclassifying a pseudocyst as an endothelial cyst
    • Cyst wall and contents of hemorrhage, debris and calcification
    • Revascularization and papillary endothelial hyperplasia often present
  • Epithelial cysts
    • Lined by a single layer of bland epithelium
    • Epithelium is cuboidal, hobnailed to flattened and can mimic endothelium
  • Hydatid cysts
    • Thick laminated / striated, acellular cyst wall
    • Cyst wall may be calcified
    • Inner germinal epithelial lining
    • Within the cyst, brood capsules containing daughter cysts form
    • Cyst contains pale eosinophilic proteinaceous material, debris and calcifications; may be able to identify calcified spherical scolices in the cyst contents
    • Pale refractile hooklets may be present but are difficult to visualize
Microscopic (histologic) images

Contributed by Debra L. Zynger, M.D. and Lan L. Gellert, M.D., Ph.D.
Endothelial cyst Endothelial cyst Endothelial cyst Endothelial cyst Endothelial cyst Endothelial cyst

Endothelial cyst


Pseudocyst Pseudocyst Pseudocyst Pseudocyst Pseudocyst Pseudocyst

Pseudocyst


Mesothelial cyst Mesothelial cyst Mesothelial cyst Mesothelial cyst Mesothelial cyst Mesothelial cyst

Mesothelial cyst


Hydatid cyst

Hydatid cyst

Cytology description
Cytology images

Images hosted on other servers:

Hydatid cyst

Negative stains
Sample pathology report
  • Left adrenal gland, adrenalectomy:
    • Endothelial cyst, 3.3 cm (see comment)
    • Comment: CD34 and D2-40 are positive. AE1 / AE3 and CK5/6 are negative.
Differential diagnosis
Board review style question #1

An adrenalectomy is performed revealing a cyst with the lining that is seen above. Which is the best diagnosis for this lesion?

  1. Endothelial cyst
  2. Epithelial cyst
  3. Parasitic cyst
  4. Pseudocyst
Board review style answer #1
D. Pseudocyst. No distinct lining is present, consistent with a pseudocyst. Careful evaluation of the lining is required because a flat, bland endothelial lining can be difficult to see. Answer A is incorrect because an endothelial lining will be present in an endothelial cyst. Epithelial and parasitic cysts are exceedingly rare. Answer B is incorrect because an epithelial lining will be present in an epithelial cyst. Answer C is incorrect because parasitic cysts usually have a thickened, striated cyst wall and calcified debris in the cyst contents.

Comment Here

Reference: Adrenal cysts
Board review style question #2

An adrenalectomy is performed, which revealed a parasitic cyst with the contents seen above. Which of the following is the most common cause of adrenal parasitic cysts with the histologic features seen in the image?

  1. Echinococcus
  2. Leishmania
  3. Strongyloides
  4. Taenia solium
  5. Toxoplasma
Board review style answer #2
A. Echinococcus. Parasitic cysts in adrenalectomy specimens are exceedingly rare. The most common cause of an adrenal parasitic cyst is Echinococcus. A striated thick cyst wall with cyst contents containing calcified scolices and debris are the characteristic histologic findings. Answer B, C, D and E are incorrect because these are not the most common causes of adrenal parasitic cysts.

Comment Here

Reference: Adrenal cysts
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