Frequency of incidental liver and renal masses accompanying adrenal incidentalomas

Year 2018, Volume: 10 Issue: 3, 220 - 227, 30.09.2018

Narin Nasiroglu Imga , Yasemin Tutuncu Mustafa Unal Mazhar Muslum Tuna Bercem Aycıcek , Serhat Isık Dilek Berker Serdar Guler

https://doi.org/10.21601/ortadogutipdergisi.395907

Abstract

Aim:
An adrenal incidentaloma (AI) is an adrenal mass incidentally found on an
imaging study that was not performed to diagnose an adrenal problem. Incidental
hepatic and renal masses are often seen in abdominal imaging; however, for this
research we aimed to determine the frequencies and kinds of hepatic and renal
incidental masses in patients with AIs.

Material
and Method: A retrospective evaluation of 381 AI
patients (245 females and 136 males) and 285 control subjects (168 females and
117 males) was conducted. The adrenal masses were divided into two groups
according to the Hounsfield unit (HU) scale (≤10 or >10) and classified as
bilateral, right, or left sided. Hepatic or renal incidental masses and those
with both were compared between AI patients and controls also; comparison was
made within AI patients.

Results:
The incidental renal mass frequency and
both hepatic and renal incidental masses frequency were found to be higher in
the AI group than in the controls. In those AI patients who had unilateral,
bilateral, and left sided adrenal masses >10 HU, the frequencies of both
hepatic and renal incidental masses were found to be greater than in the AI
patients with masses ≤10 HU (p=0.001, 0.049, and 0.001, respectively).

Conclusion:
In AI patients with adrenal masses >10 HU, due to the increased frequencies
of both hepatic and renal incidental masses, physicians should evaluate these
cases carefully. Additional large studies are needed to define the incidence
and follow-up of AI patients with hepatic and renal incidentalomas.

             

 

Keywords

Adrenal incidentalomas, renal mass, liver mass

Adrenal insidentalomaya eşlik eden karaciğer ve renal kitlelerinin sıklığı

Abstract

Amaç:
Adrenal insidentaloma (AI) adrenal dışı bir problem nedeniyle yapılan
görüntüleme yöntemleri sırasında tesadüfen saptanan adrenal beze ait
kitlelerdir. Karaciğer ve renal kitleler rastlantısal olarak abdomene ait
görüntülemelerde görülebilirler. Bu nedenle bu çalışmamızda AI hastalarında eş
zamanlı görülebilen rastlantısal hepatik ve renal kitlelerin sıklığını ve
çeşitlerini saptamayı amaçladık.

Gereç
ve Yöntem: Retrospektif olarak 381 AI hastası (245
kadın ve 136 erkek) ve 285 kontrol bireyin (168 kadın ve 117 erkek)
değerlendirilmesi yapıldı. Adrenal kitleler Hounsfield unit (HU) ölçeğine (≤10
veya>10) göre iki gruba ayrıldı ayrıca bilateral, sağ ve sol taraf kitleleri
olarak sınıflandırıldı. Karaciğer veya renal kitleleri ya da her ikisi birlikte
olanlar, hasta ile kontroller arasında ve ayrıca AI hastalarında kendi
içerisinde karşılaştırıldı.

Bulgular:
Renal kitlesi olanların sıklığı ile birlikte hepatik ve renal kitlesi olanların
sıklığı hasta grubunda kontrol grubuna göre daha yüksek bulundu. Hasta grubunda
adrenal kitle >10 HU olanlarda tek taraflı, bilateral ve sol taraflı hepatik
ve renal rastlantısal kitle sıklığı adrenal kitle ≤10 HU olan gruba göre daha
yüksek saptandı (p = 0.001, 0.049 ve 0.001; sırasıyla).

Sonuç:
Adrenal kitle > 10 HU olan AI hastalarında, hem hepatik hem de böbrek kitle
sıklığının artması nedeniyle klinisyenler bu vakaları dikkatle
değerlendirmelidir. İnsidental karaciğer ve renal kitlesi olan AI hastalarının
görülme sıklığını belirlemek ve uzun dönem takipleri için geniş çalışmalara
ihtiyaç vardır.

Keywords

Adrenal insidentaloma, böbrek kitlesi, karaciğer kitlesi

References

• References: 1. Fassnacht M, Arlt W, Bancos I et al. Management of adrenal incidentalomas: European society of endocrinology clinical practice guideline in collaboration with the European network for the study of adrenal tumors. Eur J Endocrinol 2016;175:G1-34.2. Barzon L, Sonino N, Fallo F, Palu G & Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol 2003; 149:273–85.3. Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses. Endocr Rev 1995;16:460–84. 4. Herrera MF, Grant CS, Van Heerden JA, Sheedy PF, Ilstrup DM. Incidentally discovered adrenal tumors: an institutional perspective. Surgery 1991;110:1014–21.5. Bovio S, Cataldi A, Reimondo G et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest 2006;29:298-302. 6. Boland GW, Lee MJ, Gazelle GS, Halpern EF, McNicholas MM, Mueller PR. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. Am J Roentgenol 1998;171:201–4.7. Ehrl D, Rothaug K, Herzog P, Hofer B, Rau HG. “Incidentaloma” of the liver: management of a diagnostic and therapeutic dilemma. HPB Surg 2012;891787.8. Zulke C, Loss M, Iesalnieks I et al. Benign liver lesions: indication for surgery and postoperative results. Viszeralchirurgie-stuttgart 2004;39:86-97.9. Luciani LG, Cestari R, Tallarigo C. Incidental renal cell carcinoma-age and stage characterization and clinical implications: study of 1092 patients (1982–1997). Urology 2000; 56:58–62.10. Terada N, Ichioka K, Matsuta Y, Okubo K, Yoshimura K, Arai Y. The natural history of simple renal cysts. J Urol 2002;167:21–3. 11. O'Connor SD, Pickhardt PJ, Kim DH, Oliva MR, Silverman SG. Incidental finding of renal masses at unenhanced CT: prevalence and analysis of features for guiding management. Am J Roentgenol 2011;197:139-45.12. Wunderlich H, Schumann S, Jantitzky V et al. Increase of renal cell carcinoma incidence in central Europe. European urology. 1998;33:538-41. 13. Hajdu SI, Berg JW, Foote FW Jr. Clinically unrecognized, silent renal-cell carcinoma in elderly cancer patients. J Am Geriatr Soc. 1970;18:443–449. 14. Hitzeman N, Cotton E. Incidentalomas: initial management. Am Fam Physician 2014;90:784-9.15. Ekeh AP, Walusimbi M, Brigham E, Woods RJ, McCarthy MC. The prevalence of incidental findings on abdominal computed tomography scans of trauma patients. J Emerg Med 2010;38:484-9.16. Lumbreras B, Donat L, Hernández-Aguado I. Incidental findings in imaging diagnostic tests: a systematic review. Br J Radio 2010;83:276-89.17. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet‐Tieulent J, Jemal A. Global cancer statistics, 2012. CA: a cancer journal for clinicians. 2015;65:87-108.18. Bishop JM. Molecular themes in oncogenesis. Cell 1991;64:235-48. 19. Suwa T, Chen M, Hawks CL, Hornsby PJ. Zonal expression of dickkopf-3 and components of the Wnt signalling pathways in the human adrenal cortex. J Endocrinol 2003;178:149-58. 20. Austin TW, Solar GP, Ziegler FC, Liem L, Matthews W. A role for the Wnt gene family in hematopoiesis: expansion of multilineage progenitor cells. Blood 1997; 89:3624–35.21. Taipale J, Beachy PA. The Hedgehog and Wnt signalling pathways in cancer. Nature 2001;411:349-54.22. Kojima T, Shimazui T, Hinotsu S, Joraku A, Oikawa T, Kawai K, Horie R, Suzuki H, Nagashima R, Yoshikawa K, Michiue T. Decreased expression of CXXC4 promotes a malignant phenotype in renal cell carcinoma by activating Wnt signaling. Oncogene 2009;28:297-305.23. Fleming S. Genetics of renal tumours. Cancer Metastasis Rev 1997;16:127-40. 24. Werner H, Sarfstein R. Transcriptional and epigenetic control of IGF1R gene expression: implications in metabolism and cancer. Growth Horm IGF Res 2014;24:112-8. 25. Mesiano S, Mellon SH, Jaffe RB. Mitogenic action, regulation, and localization of insulin-like growth factors in the humanetal adrenal gland. J Clin Endocrinol Metab 1993;76:968–76. 26. Kallioniemi A, Kallioniemi O-P, Sudar D et al. Comparative genomic hybridization for molecular cytogenetic analysis of solid tumors. Science 1992;258:818-21.27. Kjellman M, Kallioniemi OP, Karhu R et al. Genetic aberrations in adrenocortical tumors detected using comparative genomic hybridization correlate with tumor size and malignancy. Cancer Res 1996;56:4219-23.28. Knuutila S, Björkqvist AM, Autio K et al. DNA copy number amplifications in human neoplasms: review of comparative genomic hybridization studies. Am J Pathol 1998;152:1107.29. Nickerson ML, Warren MB, Toro JR et al. Mutations in a novel gene lead to kidney tumors, lung wall defects, and benign tumors of the hair follicle in patients with the Birt-Hogg-Dube syndrome. Cancer cell 2002;2:157-64. 30. Jochum W, Passegue E, Wagner EF. AP-1 in mouse development and tumorigenesis. Oncogene 2001;20: 2401. 31. Eferl R, Ricci R, Kenner L et al. Liver tumor development: c-Jun antagonizes the proapoptotic activity of p53. Cell 2003;112:181-92.32. Bargmann CI, Hung MC, Weinberg R. The neu oncogene encodes an epidermal growth factor receptor related protein. Nature 1986;319:226–30. 33. Prewett M, Rothman M, Waksal H, Feldman M, Bander NH, Hicklin DJ. Mouse-human chimeric anti-epidermal growth factor receptor antibody C225 inhibits the growth of human renal cell carcinoma xenografts in nude mice. Clin Cancer Res 1998;4:2957-66. 34. Huether A, Höpfner M, Baradari V, Schuppan D, Scherübl H. EGFR blockade by cetuximab alone or as combination therapy for growth control of hepatocellular cancer. Biochemical pharmacology 2005; 70:1568-78.35. Foltyn W, Strzelczyk J, Marek B et al. The usefulness of determining the serum concentrations of vascular endothelial growth factor (VEGF) and its soluble receptor type 2 (sVEGF-2) in the differential diagnosis of adrenal incidentalomas. Endokrynol Pol 2012;63:22-8. 36. Mukozu T, Nagai H, Matsui D, Kanekawa T, Sumino Y. Serum VEGF as a tumor marker in patients with HCV-related liver cirrhosis and hepatocellular carcinoma. Anticancer Res 2013; 33:1013-21. 37. Takahashi A, Sasaki H, Kim SJ et al. Markedly increased amounts of messenger RNAs for vascular endothelial growth factor and placenta growth factor in renal cell carcinoma associated with angiogenesis. Cancer Res 1994;54: 4233-7.