Adrenal gland & paraganglia
Other nonneoplastic
Cysts
Last author update: 31 March 2020
Last staff update: 19 September 2023 (update in progress)
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PubMed Search: Cysts [title] adrenal
Table of Contents
Definition / general | Essential features | Epidemiology | Clinical features | Etiology | Radiology images | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Cytology images | Positive stains | Negative stains | Differential diagnosis | Board review style question #1 | Board review style answer #1Cite this page: Gellert LL, Zynger D. Cysts. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/adrenalcysts.html. Accessed September 28th, 2023.
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
- Sometimes arises from endothelial (vascular) cyst with subsequent hemorrhage, fibrosis and hemosiderin deposition (Am J Surg Pathol 1989;13:740, Arch Pathol Lab Med 1986;110:121, Hum Pathol 1989;20:660)
- 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
- 19 year old woman with ruptured adrenal vascular cyst after trauma (Urologe A 2016;55:801)
- 26 year old woman with giant adrenal cyst displacing right kidney (Indian J Urol 2016;32:81)
- 42 year old woman with 5 cm adrenal pseudocyst (Case Rep Urol 2015;2015:234592)
- 50 year old man with giant adrenal pseudocyst (Am J Case Rep 2015;16:333)
- 51 year old woman with hydatid cyst (Korean J Urol 2014;55:493)
- 55 year old man with bulky hydatid cyst (J Minim Access Surg 2015;11:279)
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:
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., Lan L. Gellert, M.D., Ph.D. and @ahmsab_MD on Twitter
Endothelial cyst
Hydatid cyst
Hydatid cyst
Cysts
Images hosted on other servers:
Pseudocyst
Cytology images
Images hosted on other servers:
Hydatid cyst
Negative stains
Differential diagnosis
- Adrenocortical neoplasm with cystic change: inhibin+, melanA+, CD31-, CD34-, ERG-, D2-40- (Mod Pathol 1997;10:530)
- Pheochromocytoma with cystic change: synaptophysin+, chromogranin+, S100+, CD31-, CD34-, ERG-, D2-40-
Board review style question #1
Which of the following is the most common cause of adrenal parasitic cysts?
- Echinococcus
- Leishmania
- Strongyloides
- Taenia solium
- Toxoplasma
Board review style 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)
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Reference: Cysts (endothelial, pseudocyst, parasitic)
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Reference: Cysts (endothelial, pseudocyst, parasitic)
