BLACK ADENOMA OF THE ADRENAL GLAND

Czech version

Authors: Miroslav Polák ¹; Petr Stránský ¹; Ivan Trávníček ¹; Michal Krčma ²; Ondřej Daum ³; Ondřej Hes ³; Mirka Hynek ⁴; Radek Tupý ⁴; Milan Hora ¹
Authors‘ workplace: Urologická klinika LF UK a FN Plzeň ¹; 1. interní klinika LF UK a FN Plzeň ²; Šiklův ústav patologie LF UK a FN Plzeň ³; Klinika zobrazovacích metod LF UK a FN Plzeň ⁴
Published in: Ces Urol 2016; 20(2): 141-147
Category: Original Articles

Overview

Aim:
The presentation of a morphologically abnormal type of adrenal adenoma, the so-called black adenoma, with a description of four own case histories.

Materials and methods:
Laparoscopic adrenalectomy /LAE/ has been performed at the Urological Department of the University Hospital in Pilsen since 2003. 138 laparoscopic adrenalectomies were performed until the end of 2015. Final histology showed adenoma of adrenal gland in 53 operated cases (35.33 %). Out of those, black adenoma of adrenal gland was identified in 4 patients‘ /2 men and 2 women/ (2.66 %), which we present in this report.

It is a pigmented type of adrenal adenoma, colored by accumulation of lipofuscin pigment. In three patients the adrenal adenoma was discovered during imaging investigations to exclude a secondary cause of hypertension and as an incidental discovery during one man‘s examination of hematuria. Contrast CT scans of abdomen were done in all the cases. Laparoscopic adrenalectomy was performed in all the cases. Both women underwent a single-port one (LESS). The black adenoma of the adrenal gland was described by a pathologist.

Conclusion:
The black adenoma of the adrenal gland is a rare type of adenoma. It has a distinct macroscopic appearance that is caused by the accumulation of lipofuscin pigment. There is no clinical importance compared to common adenoma.

Key words:
Adrenalectomy, adrenal tumour, black adenoma, laparoendoscopic single-site surgery, laparoscopy.

Sources

1. Kršek M. Náhodně zjištěné tumory nadledvin. Postgraduální medicína – Mimořádná příloha. 2006; 8: 0–27.

2. Hanuš T. Urologie – lékařské repetitorium. 2010: 151–157.

3. Willatt JM, Francis IR. American family physician, radiologic evaluation of incidentally discovered adrenal masses. 2010; 81(11): 1361.

4. Barzon F, Fallo F, Sonino N, Bosaro M. Prevalence and the natural couse of adrenal incidentaloma, NIH State-of-the-Science Conference on Management of the Clinically InapparentAdrenal Mass (“Incidentaloma”). NIH, Bethesda, 2002: 27.

5. Hyndrák T, Hora M, Chudáček Z, Hes O. Aneuryzmatická cysta nadledviny. Ces Urol 2014; 18(2): 134–137.

6. Fonseca JJS, Pirola S. Black Adenoma of the Adreanl Gland. Images in Pathology, 2/2014 X.

7. Dindo D, Demartines N, Clavien PA. Classification of surgical complications, a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2): 205–213.

8. Hartmann I, Grepl M, Šmakal O, et al. Laparoskopická adrenalektomie ve FN Olomouc – patnáctileté zkušenosti. Ces Urol 2013; 17(4): 246–253.

9. Šafařík L, Vraný M, Widimský J, et al. Laparoskopická transperitoneální adrenalektomie u hormonálně aktivních nádorů nadledvin. Rozhl Chir, 2002; 3: 127–132.

10. Stránský P, Hora M, Eret V, et al. Laparoskopická adrenalektomie. Rozhl Chir, 2009; 88(9): 514–520.

11. Hora M, Ürge T, Stránský P, et al. Laparoendoscopic single-site surgery (LESS) adrenalectomy – own experience and matched case-control study with standard laparoscopic adrenalectomy. Videosurgery Miniinv, 2014; 9(4): 596–602.

12. Baker M R. A pigmented adenoma of the adrenal. 1938, Arch Path: 845–852.

13. Robinson M J, Pardo V, Rywlin AM. Pigmented nodules (black adenomas) of the arenal: an autopsy study of incidence, morphology and function. Hum Pathol. 1972; 27: 317–325.

14. Kameyama K, Takami H. Pigmented Granules in Functional Black Adenoma of the Adrenal Gland: A Histochemical and Ultrastructural Study. Endocrine Pathology, 1999; 4: 353–357.

15. Hora M, Eret V, Ürge T, et al. Role laparoskopie v urologii. Ces Urol, 2011; 15(2): 93–100.