Cysts and tumors of the adrenal glands with cystic transformation. Comparison of the results of surgical treatment, puncture techniques and non-surgical management

The article presents the results of a multicenter study of the treatment results of 35 patients with a preliminary clinical diagnosis of "adrenal cyst" who underwent various types of surgical operations or underwent non-surgical management. Radical operations were performed in 13 patients, puncture treatment in 22 patients. The incidence of tumors with cystic transformation among all patients with a preliminary clinical diagnosis of adrenal cyst was 15.4%, of which pheochromocytoma was 13.4%. Of the 13 operated patients, pheochromocytoma was detected in 23.1% of patients, in 76.9% benign tumors with cystic transformation and simple cysts were detected.
BACKGROUND: Adrenal cysts are rare neoplasms of this localization. Among all tumors of the adrenal glands, cysts occur in 5–10%. Parasitic cysts due to echinococcal disease — up to 7%. Randomly identified cysts during X-ray examinations are observed in 5–9%. According to the results of autopsies, cysts amount to 0.06–0.18%.
AIM: Evaluation and improvement of the results of differential diagnosis and treatment of patients with a preliminary clinical diagnosis of adrenal cyst.
MATERIALS AND METHODS: The analysis of the results of examination, treatment and follow-up of 52 patients with a preliminary clinical diagnosis of "adrenal cyst" who were treated in six hospitals of the Moscow Department of Health from 2009 to 2023 was carried out. A retrospective analysis of CT images was performed in all radically operated patients and in 8 who underwent puncture treatment. CT criteria for simple cysts and tumors with cystic transformation are described, taking into account morphological results in radically operated patients. The long-term results of surgical treatment were evaluated in comparison with the results of observational (nonoperative) management tactics.
RESULTS: Reliable CT criteria of a simple adrenal cyst have been identified, on the basis of which indications for surgical or non-surgical treatment of patients have been proposed. A comparison of the results of dynamic observation, sclerosis and radical surgery revealed that sclerosis is characterized by the highest frequency of complications (13.5%) and the lowest efficiency, and adrenalectomy / resection is characterized by a high frequency of "vain operations" — in 10 out of 13 cases (76.9%) in the absence of absolute indications for surgical treatment. The frequency of discrepancies in clinical and morphological diagnosis (cyst/tumor) was 8 out of 13 operated patients (61.5%, p-value <0.0001), and the frequency of critical discrepancy (cyst/pheochromocytoma) was 3 out of 13 operated (23.1%, p-value 0.044). At the same time, the reverse interpretation of the data obtained is of clinical importance: the decision on surgical treatment in this group of patients was 
correct in 23.1% of the operated patients — in the case of pheochromocytomas, whereas in the remaining 10 out of 13 cases (76.9%) there were no absolute indications for surgical treatment.
CONCLUSION: Nonoperative management (dynamic follow-up) of patients with simple adrenal cysts is characterized by the best results in comparison with both types of surgical treatment.

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