Laparoscopic management of a giant adrenal cyst

Yi-Chun Chou^a, Chih-Wen Lin^b, Chang-Kuo Wei^{c, d}, Jen-En Tseng^{d, e}, Kuo-Chih Tseng^{a, d}

^a Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^b Department of Medical Imaging, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^c Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^d School of Medicine, Tzu Chi University, Hualien, Taiwan
^e Department of Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan

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Abstract
Adrenal cysts, a rare entity, are usually nonfunctional and asymptomatic. Here, we report a 32-year-old woman who presented with mild breathlessness and vague abdominal fullness and discomfort that had lasted 6 months. Chest radiography showed elevation of the left side of the diaphragm. Abdominal sonography showed an anechoic lesion of >15 cm, without a septum, that was situated over the left abdominal area. Abdominal computed tomography (CT) showed a 20 cm suprarenal cyst located between the pancreas, spleen, and left kidney, causing anterior displacement of the pancreas and inferior displacement of the left kidney. Magnetic resonance imaging confirmed the CT and sonographic findings, and revealed that the cystic mass was originating from the left adrenal gland. Fluid analysis of the cystic lesion showed no evidence of infection or malignancy. A laparoscopic adrenalectomy was performed. Histopathologically, the adrenal tissue showed no evidence of adenoma or malignancy, and the cystic component showed a flattened endothelial lining with fibrotic tissue, consistent with an endothelial cyst. The postoperative course was uneventful and the patient had no evidence of recurrence during a 6-year follow-up. We discuss the diagnosis and management of adrenal cysts.

Keywords
Adrenal cyst; Adrenalectomy; Laparoscopy