https://doi.org/10.4081/aiua.2021.4.481

Ectopic adrenal tissue in the kidney: A systematic review

Vol. 93 No. 4 (2021)
Published: December 21, 2021
Intrarenal adrenal tissue, Ectopic adrenal tissue, Renal-adrenal fusion, Adrenal rest, Incidental renal masses, Renal cancer, Small renal mass
Abstract Views: 1352
PDF: 587
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Davide De Marchi
Department of Urology, San Raffaele Hospital, Milan, Italy.
Alessandro Tafuri
tafuri.alessandro@gmail.com
Department of Urology, “Vito Fazzi” Hospital, Lecce; Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona; Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.
Guglielmo Mantica
Department of Urology, University of Genova, Ospedale San Martino, Genova, Italy.
Aliasger Shakir
USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, United States.
Federico Scarfò
Department of Pathology, San Raffaele Hospital, Milan, Italy.
Giovanni Passaretti
Department of Urology, San Raffaele Hospital, Milan, Italy.
Salvatore Smelzo
Department of Urology, San Raffaele Hospital, Milan, Italy.
Silvia Proietti
Department of Urology, San Raffaele Hospital, Milan, Italy.
Lorenzo Rigatti
Department of Urology, San Raffaele Hospital, Milan, Italy.
Roberta Luciano
Department of Pathology, San Raffaele Hospital, Milan, Italy.
Alessandro Antonelli
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
Vincenzo Pagliarulo
Department of Urology, “Vito Fazzi” Hospital, Lecce, Italy.
Rosario Leonardi
Department of Urology, San Raffaele Hospital, Milan, Italy.
Guido Giusti
Department of Urology, San Raffaele Hospital, Milan, Italy.
Franco Gaboardi
Department of Urology, San Raffaele Hospital, Milan, Italy.

Introduction: Ectopic adrenal tissue in the kidney, including “Ectopic adrenal tissue” and “Adrenal-renal fusion”, is a rare event with a specific behavior which may be difficult to distinguish clinically from renal neoplasms. We performed a systematic review on ectopic adrenal tissue variants reported in the literature underlining its clinical aspects.
Methods: Manuscripts which presented a case report or case series of ectopic adrenal tissue in the kidney were included even if published in original articles, reviews, or letters to the editor. A specific search on SCOPUS®, PubMed®, and Web of Science® database was performed. Only English language papers published in a period ranging between August 1991 and April 2020 were considered. Additionally, a case we had at our institution is described, and its characteristics are included. Data on clinical presentation, type of adrenal anomaly, location, anatomopathological and immune-histotype characteristics were collected.
Results: We identified 888 manuscripts. Among these 29 were included in this systematic review. Overall, 39 patients with renal adrenal fusion or adrenal ectopia were considered. In most cases, the diagnosis was made incidentally, or following investigation for flank pain, abdominal pain, or endocrinological disorders. CT scan frequently identified a solid vascularized lesion that was difficult to distinguish from renal neoplasm. Adrenal fusion was mostly located at the level of the upper pole. Adrenal rest was found in the renal parenchyma, renal hilum, or retroperitoneum in close proximity to the renal peduncle. Often these ectopic adrenal tissue lesions follow a benign behavior and can be classified as functioning or non-functioning adenomas. Rarely, they may experience neoplastic degeneration. The most frequently positive markers were inhibin, vimentin, melan-A, synaptophysin and anti-p450 scc.
Conclusions: Ectopic adrenal tissue in the kidney is a rare event with specific clinical characteristics that need to be identified in order to arrive at a correct diagnosis and carry out appropriate treatment management.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Ferlay J, Colombet M, Soerjomataram I, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer. 2018; 103:356-387. DOI: https://doi.org/10.1016/j.ejca.2018.07.005
Akdogan B, Gudeloglu A, Inci K, et al. Prevalence and predictors of benign lesions in renal masses smaller than 7 cm presumed to be renal cell carcinoma. Clin Genitourin Cancer. 2012; 10:121-5. DOI: https://doi.org/10.1016/j.clgc.2012.01.005
Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. Eur Urol. 2019; 75:799-810. DOI: https://doi.org/10.1016/j.eururo.2019.02.011
Mir MC, Capitanio U, Bertolo R, et al. Young Academic Urologists Kidney Cancer working group of the European Urological Association. Role of active surveillance for localized small renal masses. Eur Urol Oncol. 2018; 1:177-187. DOI: https://doi.org/10.1016/j.euo.2018.05.001
Brcˇ ic´ I, Lenicˇek T, Ulamec M, et al. Intrarenal ectopic adrenal tissue associated with renal angiomyolipoma. Pathol Int. 2011; 61:778-80. DOI: https://doi.org/10.1111/j.1440-1827.2011.02724.x
Chin L, Brody RI, Morales P, Black VH. Immunocytochemical characterization of intrarenal adrenal tissue. Urology. 1994; 44:429-32. DOI: https://doi.org/10.1016/S0090-4295(94)80110-X
von Rokitansky, KF. A manual of pathological anatomy. Vol. 3. 1855: Blanchard & Lea.
Bamford R, Bretherton J, Rosenfelder N, Bell J. Bilateral adrenalrenal fusion: A radiological diagnosis. BJR Case Rep. 2018;5:20180108. DOI: https://doi.org/10.1259/bjrcr.20180108
Wang XL, Dou JT, Gao JP, et al. Laparoscope resection of ectopic corticosteroid-secreting adrenal adenoma. Neuro Endocrinol Lett. 2012; 33:265-7.
Zhang J, Liu B, Song N, et al. An ectopic adreocortical adenoma of the renal sinus: a case report and literature review. BMC Urol. 2016; 16:3. DOI: https://doi.org/10.1186/s12894-016-0123-0
Ye H, Yoon GS, Epstein JI. Intrarenal ectopic adrenal tissue and renal-adrenal fusion: a report of nine cases. Mod Pathol. 2009;22:175-81. DOI: https://doi.org/10.1038/modpathol.2008.162
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS med. 2009; 6:e1000097. DOI: https://doi.org/10.1371/journal.pmed.1000097
Szumera A, Oko´n K, Dobrowolska B, Dobrowolski Z. Adrenal rest presenting as a renal cyst. A case report. Pol J Pathol. 2003; 54:273-6.
Goren E, Engelberg IS, Eidelman A. Adrenal rest carcinoma in hilum of kidney. Urology. 1991; 38:187-90. DOI: https://doi.org/10.1016/S0090-4295(05)80085-8
Colberg JW, Cai X, Humphrey PA. Unilateral adrenal heterotopia with renal-adrenal fusion. J Urol. 1998; 160:116. DOI: https://doi.org/10.1097/00005392-199807000-00044
Ayala AR, Basaria S, Udelsman R, et al. Corticotropin-independent Cushing's syndrome caused by an ectopic adrenal adenoma. J Clin Endocrinol Metab. 2000; 85:2903-6. DOI: https://doi.org/10.1210/jcem.85.8.6749
Souverijns G, Peene P, Keuleers H, Vanbockrijck M. Ectopic localisation of adrenal cortex. Eur Radiol. 2000; 10:1165-8. DOI: https://doi.org/10.1007/s003309900263
Fan F, Pietrow P, Wilson LA, et al. Adrenal pseudocyst: a unique case with adrenal renal fusion, mimicking a cystic renal mass. Ann Diagn Pathol. 2004; 8:87-90 DOI: https://doi.org/10.1053/j.anndiagpath.2004.01.005
Hsu TH, Kessler R. Ectopic adrenal tissue as radiographic lymphadenopathy in renal cell carcinoma. Int Urol Nephrol. 2005;37:25-6. DOI: https://doi.org/10.1007/s11255-004-6081-6
Claahsen-van der Grinten HL, Duthoi K, Otten BJ, et al. An adrenal rest tumour in the perirenal region in a patient with congenital adrenal hyperplasia due to congenital 3beta-hydroxysteroid dehydrogenase deficiency. Eur J Endocrinol. 2008; 159:489-91 DOI: https://doi.org/10.1530/EJE-08-0311
Linder B, Hong Y, Jarrett T. Intra-renal adrenal adenoma: a compelling addition to the differential diagnosis of renal mass. Int J Urol. 2009; 16:912-4. DOI: https://doi.org/10.1111/j.1442-2042.2009.02372.x
Mahadevia S, Rozenblit A, Milikow D, Marinovich A. Renaladrenal fusion: instance of an adrenal adenoma mimicking a solid renal mass at CT--case report. Radiology. 2009; 251:808-12. DOI: https://doi.org/10.1148/radiol.2511081151
Louiset E, Gobet F, Libé R, et al. ACTH-independent Cushing's syndrome with bilateral micronodular adrenal hyperplasia and ectopic adrenocortical adenoma. J Clin Endocrinol Metab. 2010;95:18-24. DOI: https://doi.org/10.1210/jc.2009-0881
Cardinalli IA, de Oliveira-Filho AG, Mastellaro MJ, et al. A unique case of synchronous functional adrenocortical adenoma and myelolipoma within the ectopic adrenal cortex in a child with Beckwith-Wiedemann syndrome. Pathol Res Pract. 2012; 208:189-94 DOI: https://doi.org/10.1016/j.prp.2011.12.011
Yokoyama H, Adachi T, Tsubouchi K, et al. Non-functioning adrenocortical carcinoma arising in an adrenal rest: immunohistochemical study of an adult patient. Tohoku J Exp Med. 2013;229:267-70. DOI: https://doi.org/10.1620/tjem.229.267
Tong A, Jia A, Yan S, et al. Ectopic cortisol-producing adrenocortical adenoma in the renal hilum: histopathological features and steroidogenic enzyme profile. Int J Clin Exp Pathol. 2014; 7:4415-21
Godin K, Bang N, Tolkach Y. Case report: Heterotopic intrarenally located adrenocortical oncocytoma. F1000Res. 2014; 3:73. DOI: https://doi.org/10.12688/f1000research.3780.2
Boll G, Rattan R, Yilmaz O, Tarnoff ME. Intraoperative identification of adrenal-renal fusion. J Minim Access Surg. 2015; 11:205-6. DOI: https://doi.org/10.4103/0972-9941.159855
St Clair S, Machnicki S, Yurovitsky A. Adrenal renal fusion confusion: a case report of an adrenal cortical adenoma with adrenalrenal fusion. Clin Imaging. 2015; 39:695-8 DOI: https://doi.org/10.1016/j.clinimag.2014.12.022
Zhao Y, Guo H, Zhao Y, Shi B. Secreting ectopic adrenal adenoma: A rare condition to be aware of. Ann Endocrinol (Paris). 2018;79:75-81. DOI: https://doi.org/10.1016/j.ando.2017.03.003
Lee JH, Choi YD, Cho NH. An Intrarenal adrenocortical carcinoma arising in an adrenal rest. J Pathol Transl Med. 2018; 52:416-419. DOI: https://doi.org/10.4132/jptm.2018.07.20
Baydar D, Aydin O. Confusing cases: clear cell but not renal cell lesions in kidney. Pathol Int. 2008; 58:713-7. DOI: https://doi.org/10.1111/j.1440-1827.2008.02298.x
Liu Y, Jiang YF, Wang YL, et al. Ectopic adrenocortical adenoma in the renal hilum: a case report and literature review. Diagn Pathol. 2016; 11:40. DOI: https://doi.org/10.1186/s13000-016-0490-6
Sappal S, Sulek J, Smith SC, Hampton LJ. Intrarenal adrenocortical adenoma treated by robotic partial nephrectomy with adrenalectomy. J Endourol Case Rep. 2016; 2:41-3. DOI: https://doi.org/10.1089/cren.2016.0017
Lu D, Yu N, Ma X, et al. An ectopic adrenocortical adenoma in renal hilum presenting with Cushing's syndrome: A case report and literature review. Medicine (Baltimore). 2018; 97:e13322. DOI: https://doi.org/10.1097/MD.0000000000013322
van Oostenbrugge TJ, Fütterer JJ, Mulders PFA. Diagnostic imaging for solid renal tumors: a pictorial review. Kidney Cancer. 2018; 2:79-93. DOI: https://doi.org/10.3233/KCA-180028
Marconi L, Dabestani S, Lam TB, et al. Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Eur Urol. 2016; 69:660-673. DOI: https://doi.org/10.1016/j.eururo.2015.07.072
Haramis G, Mues AC, Rosales JC, et al. Natural history of renal cortical neoplasms during active surveillance with follow-up longer than 5 years. Urology. 2011; 77:787-91. DOI: https://doi.org/10.1016/j.urology.2010.09.031

How to Cite

De Marchi, D., Tafuri, A. ., Mantica, G. ., Shakir, A. ., Scarfò, F. ., Passaretti, G. ., Smelzo, S. ., Proietti, S. ., Rigatti, L. ., Luciano, R. ., Antonelli, A. ., Pagliarulo, V. ., Leonardi, R. ., Giusti, G. ., & Gaboardi, F. . (2021). Ectopic adrenal tissue in the kidney: A systematic review. Archivio Italiano Di Urologia E Andrologia, 93(4), 481–488. https://doi.org/10.4081/aiua.2021.4.481

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.