Surgical Management of Adrenal Tumors: Experience of Three Tertiary Hospitals in Yaounde, Cameroon

Introduction: Surgical management of adrenal tumors has greatly improved over the past years, with laparoscopic adrenalectomy being the gold standard. However, Open adrenalectomy is indicated in large adrenal tumors, malignant tumors and large phaeochromocytomas. We report surgical outcomes of 18 cases of functional adrenal tumors from 2007 to 2022. Methods: We conducted a retrospective cross-sectional and descriptive study in three tertiary hospitals in Yaounde, Cameroon. We reviewed files of patients who underwent adrenalectomy over a period of 15 years from July 2007 to July 2022. Clinical and diagnostic components of adrenal tumors, indications and surgical outcomes were analyzed. Results: A total of 18 patients were included in our study. The average age of patients was 38.33 years, with a female-to-male sex ratio of 2:1. Weight gain (72.2%) was the most represented clinical sign. The secretory nature of tumor and malignancy represented 55.5% and 33.3% of the operative indications and all 18 (100%) of the patients had open adrenalectomy. Vascular injury was the most common intraoperative complication with 5.63%, while acute adrenal insufficiency (16.7%) was the most common post-operative complication. The average tumor size was 6.22 cm and the mean duration of hospitalization was 11.61 days. Adenoma 7 (38.9%) and adrenocortical carcinoma 5 (27.8%) were the frequent histological types. One patient died two months post-surgery from anemia-related complications. Conclusion: The success of adrenal surgery is linked to multidisciplinary patient care and the experience of the surgeon. Conventional surgery still has indications with satisfactory short- and medium-term results in our context.

Application of retroperitoneal laparoscopy and robotic surgery in complex adrenal tumors

As a surgical method for the treatment of adrenal surgical diseases,laparoscopy has the advantages of small trauma,short operation time,less bleeding,and fast postoperative recovery.It is considered as the gold standard for the treatment of adrenal surgical diseases.Retroperitoneal laparoscopy is widely used because it does not pass through the abdominal cavity,does not interfere with internal organs,and has little effect on gastrointestinal function.However,complex adrenal tumors have the characteristics of large volume,compression of adjacent tissues,and invasion of surrounding tissues,so they are rarely treated by retroperitoneal laparoscopy.In recent years,with the development of laparoscopic technology and the progress of surgical technology,robotic surgery has been gradually applied to the surgical treatment of complex adrenal tumors.This paper reviews the clinical application of retroperitoneal laparoscopic surgery and robotic surgery in the treatment of complex adrenal tumors.

Surgical approaches of adrenal tumors( report of 1077 cases)

Objective To identify the optimal surgical approaches for the resection of adrenal tumors. Methods The choices and effects of surgical approaches in 1 077 patients with adrenal tumors of varying sizes and types were analyzed. Results An 11th or 10th intercostal incision was used for 567 cases of aldosterone-producing adrenocortical tumors (APA) and Cushing syndrome (CUS). An llth or 10th incision was used in 173 cases of pheochromocytomas and 136 cases of incidental tumors. Transabdominal approach was performed in 136 cases of pheochromocytomas and 22 cases of incidental tumors. Twenty-five patients recieving thoracoabdominal approach were all those with pheochromocytomas or incidental tumors. Nine patients with adrenal tomors less than 4 cm in diameter received laparoscopic surgery. Surgeries included 1 060 cases of tumor resection and 17 cases of biopsies, and splenectomy was procedured in 9 patients simultaneously. The main complication of 11th or 10th intercostal incision approach was pleural

Association of erythropoietin gene rs576236 polymorphism and risk of adrenal tumors in a Chinese population

Erythropoietin（EPO） is a circulating glycosylated protein hormone and has been implicated in the development and progression of non-hematopoietic tissue tumors.The objective of the present study was to determine if the EPO rs576236 polymorphism was associated with the risk of adrenal tumors.We genotyped the EPO rs576236 polymorphism in a case-control study of 288 adrenal tumor patients and 456 cancer-free controls by using the TaqMan method,and assessed the association between the polymorphism and the adrenal tumor risk by logistic regression.Furthermore,95%confidence interval（CI） was used to assess the genetic association between the polymorphism and the risk of adrenal tumor.Compared with the TT genotype,the TC genotype had a significantly increased risk of adrenal tumor[adjusted odds ratio（OR） = 1.24,95%CI = 1.12-2.22].Furthermore a significantly increased risk of adrenal tumor was found in the combined variant genotypes TC＋CC compared with the TT genotype（adjusted OR = 1.17,95%CI = 1.12-2.21）.Our present study suggests that the rs576236 polymorphism of EPO confers susceptibility to adrenal tumor in the Chinese population.

Primary adrenal Ewing sarcoma:A systematic review of the literature

BACKGROUND Ewing sarcoma(ES)is a malignant neoplasm of neuroectodermal origin and is commonly observed in children and young adults.The musculoskeletal system is the main body system impacted and ES is rarely seen in the visceral organs particularly the adrenal gland.AIM To present a comprehensive review of primary adrenal ES,with emphasis on diagnosis,therapy and oncological outcomes.METHODS A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020.PubMed/MEDLINE,EMBASE and Google Scholar bibliographic databases were searched to identify articles from 1989 to 2022 and included patients with ES/primitive neuroectodermal tumor(PNET)of the adrenal gland.PubMed,Google Scholar and EMBASE medical databases were searched,combining the terms“adrenal”,“ES”and“PNET”.Demographic,clinical,pathological and oncological data of patients were analyzed by SPSS version 29.0.RESULTS A total of 52 studies were included for review(47 case reports and 5 case series)with 66 patients reported to have primary adrenal ES.Mean age at diagnosis was 26.4±15.4 years(37.9%males,57.6%females,sex not reported in 3 cases).The most frequent complaint was abdominal/flank pain or discomfort(46.4%)followed by a palpable mass(25.0%),and the average duration of symptoms was 2.6±3.1 mo.The imaging modality of choice was computed tomography scan(81.5%),followed by magnetic resonance imaging(20.4%).Preoperative staging revealed that 17 tumors(27.9%)were metastatic and 14 patients had inferior vena cava or renal vein neoplastic thrombus at initial diagnosis.Open adrenalectomy was performed in the majority of cases(80.0%),of which 27.9%required more extensive resection.Minimally invasive surgery was attempted in 8.2%of tumors.Complete surgical resection was achieved in 89.4%of the patients.Adjuvant therapy was administered to 32 patients,in the form of chemotherapy(62.5%),radiotherapy(3.1%)or combination(34.4%).Median overall survival was 15 mo and 24-mo overall survival was 40.5%.Median disease-free survival was 10 mo and 24-mo disease-free survival was 33.3%.CONCLUSION The significant progress in molecular biology and genetics of ES does not reflect on patient outcomes.ES remains an aggressive tumor with a poor prognosis and high mortality.

Giant adrenal tumor presenting as Cushing’s syndrome and pheochromocytoma:A case report

We report a case of a 35-year-old lady who presented with Cushingoid features and associated raised urinary metanephrine.The patient underwent open adrenelectomy.Histopathological examination revealed adreno-cortical carcinoma with microscopic lymphovascular invasion.Postoperative period was uneventful and is on follow-up for the last one year and is doing well.

Corticosurrenaloma: About a Pediatric Case

Introduction: This study aims to describe the outcome of adrenocortical cancer in children through observation. Observation: A 10-year-old girl with no previous pathological history. She presented headaches and severe hypertension with clinical and biological signs of hyperandrogenism for 6 months. An abdominal CT scan showed an encapsulated left adrenal mass without local or regional invasion or secondary location. A pheochromocytoma or adrenal neuroblastoma was first suspected. The blood pressure was stable at 130/65 mmHg under antihypertensive drugs. She underwent a complete tumor resection without any intraoperative incident. The pathologic study confirmed the adrenocortical carcinoma scored Weiss 7. The severe high blood pressure reappeared 2-year later despite antihypertensive drugs. The thoracic abdominal and pelvic CT scan showed a locally advanced tumor recurrence in the left adrenal gland with parenchymal nodes in the lungs and liver. The outcome was fatal despite medical and surgical management. Conclusion: Adrenocortical cancer is a rare tumor. It is important to hormonal testing in the presence of Cushing’s syndrome in children. It can give a strong indication of the diagnostic possibilities. Histology confirms the diagnosis. The evolution is covered by complications, in particular recurrence with life-threatening metastases.

Myxoid adrenal cortical tumor： report of four cases

Myxoid adrenocortical neoplasms are rare. Surgical resection of the mass is the first-line therapy. Here we reported a total of four patients, aged 44-66 years, diagnosed with myxoid adrenocortical tumor. The clinical characteristics and immunohistochemical features of the tumor are discussed in the current literature.