Comparison And Analysis Of Clinical Features Between Adrenal Cyst And Adrenal Adenoma

Purpose:Through the analysis and comparison of the clinical manifestations and imaging examinations of the cases of adrenal cyst and adrenal adenoma confirmed by postoperative pathology,the differences in various aspects and the causes of misdiagnosis between the two groups were clarified,so as to increase the diagnosis rate of adrenal cyst and facilitate the perioperative management of patients.Methods:Retrospective analysis was performed on the clinical and imaging manifestations of 36 patients who were admitted to our hospital for postoperative pathological diagnosis of adrenal cyst from January 2016 to December 2018 and 39 patients who were admitted to our hospital for postoperative pathological diagnosis of adrenal cortical adenoma from August 2012 to December 2018.SPSS version 24.0 was used for analysis to compare the similarities and differences in various aspects.Results:The age of patients with adrenal cyst ranged from 17 to 67 years old,with a median age of 47 years old.The age of patients with adrenal adenoma ranged from 32 to 69 years old,and the median age was 55 years old,among which the patients aged from 50 to 60 years old were the most,accounting for 38%.There were 36 cases of adrenal cyst,among which 24 cases were misdiagnosed as adrenal tumor preoperatively,the misdiagnosis rate was 67%.There were 39 cases of adrenal adenoma without misdiagnosis.Among the patients with adrenal cyst,4 cases were found to have lesions due to abdominal discomfort,8 cases were found to have lesions due to hypertension,and 24 cases were found to have lesions due to physical examination.Among the cases of adrenal adenoma,15 cases were found to have lesions due to simple hypertension,18 cases were found to have lesions due to physical examination,5 cases were found to have lesions due to the manifestations of primary aldosteronism,and 1 case was found to have lesions due to dizziness.There were 36 patients in the adrenal cyst group,and 13 patients underwent color doppler ultrasonography of the urinary system.Among them,12 patients were diagnosed with cystic mass and 1 patient with substantive mass.Two cases of adenoma were diagnosed as adrenal gland adenoma.Both groups of patients received adrenal CT plain scan + phase ii enhanced examination,and 4 patients in the adrenal cyst group presented dotted or curved calcification lesions,while no calcification lesions were observed in the adrenal adenoma group.There were 3 hemorrhage changes in the adrenal cyst group,but no hemorrhage changes in the adrenal adenoma group.The mean maximum diameter of adrenal cyst was 4.6cm,and themean maximum diameter of adrenal adenoma group was 2.5cm.The mean value of adrenal CT plain scan of the two groups was 11.13±16.857 HU,15.08± 4.759 HU,respectively.There was no statistical difference between the two groups(p> 0.05).The mean value of arterial CT was 45.36 ±27.051 HU,17.06 ±4.510 HU,respectively.The mean value of intravenous CT scan was 48.13 ±18.92 HU and 16.58 ±4.34 HU,respectively,with statistical difference(p < 0.05).CT mean values of arterial phase-plain scan were 34.51 ±20.16 HU and 1.97±2.62 HU,respectively,with statistical difference(p< 0.05).The mean CT values of arterial and venous phases were-2.77 ±17.72 HU and 0.47 ±2.18 HU,respectively,with no statistical difference(p> 0.05).In the adrenal cyst group,3 patients underwent MRI examination,and 1 patient was misdiagnosed.MRI examination was performed in 3 patients in the adrenal adenoma group,and no misdiagnosis was found.Conclusion:1.Hypertension is not a specific symptom of adrenal adenoma.Some patients with adrenal cyst may be associated with hypertension at the same time.The qualitative diagnosis of adrenal mass with hypertension should follow other objective indicators.2.CT plain scan cannot effectively distinguish adrenal cyst from adrenal adenoma,and should be judged according to the CT value of each stage of the lesion and the degree of change of different periods.3.MRI has a higher diagnostic value for adrenal cyst than CT,which shows uneven density inside the lesion.MR can be further used to identify the lesions that are difficult to be diagnosed.4.For simple adrenal cyst,color ultrasound diagnosis rate is high,and for adrenal cyst with bleeding,adrenal cyst separated cases,color ultrasound may be misdiagnosed.5.The diagnosis of adrenal cysts should be considered first in patients with CT findings of lesions with calcification or internal bleeding.