Post on 26-Mar-2015
transcript
Algoritmo decisionale e terapeutico
negli incidentalomi surrenalici
Algoritmo decisionale e terapeutico
negli incidentalomi surrenalici
Micaela PiccoliMicaela Piccoli
Divisione di Chirurgia Generale(Primario: Prof. Gianluigi Melotti)
Ospedale Sant’AgostinoModena, Italia
Scuola Speciale ACOI
di Chirurgia laparoscopica e mini-invasiva
(Direttore: Prof. Gianluigi Melotti)
www.acoi.it
XXIV CONGRESSO NAZIONALE ACOI25/28 Maggio 2005 - Montecatini
Terme
NIH Consensus and State-of-the Science Statements
2002, Feb 4-6;9(2);1-25
NIH Consensus and State-of-the Science Statements
2002, Feb 4-6;9(2);1-25
Management of the ClinicallyManagement of the Clinically Inapparent Adrenal MassInapparent Adrenal Mass
(“Incidentaloma”)(“Incidentaloma”)
Management of the ClinicallyManagement of the Clinically Inapparent Adrenal MassInapparent Adrenal Mass
(“Incidentaloma”)(“Incidentaloma”)
IncidentalomaIncidentaloma
• Ormonalmente attivo o non funzionante ?• Benigno o maligno ?
• Se funzionante: surrenalectomia• Se non funzionante:
– > 6 cm surrenalectomia; – < 4 cm (senza sospetti nell’imaging) monitoraggio– 4-6 cm ?
Quale intervento?Controindicazioni all’appproccio laparoscopico?
Quale intervento?Controindicazioni all’appproccio laparoscopico?
• Invasive adrenal carcinoma• Malignant pheochromocytoma
Size
Infiltrating mass
• Laparoscopic adrenalectomy is also effective and safe for large lesions….The risk of encountering an incidental adrenal cortical cancer is significantly increased for large lesions, and therefore, in these cases, additional attention is required to observe oncologic surgical principles
Urology 2002 Nov 60(5):801-5. Case-history :125 patients
Laparoscopic adrenalectomyThe size of the mass
Laparoscopic adrenalectomyThe size of the mass
Laparoscopic adrenalectomyThe size of the mass
Laparoscopic adrenalectomyThe size of the mass
Does tumor eterogeneity limit the use of the Weiss criteria in the evoluation
of adrenocortical tumours ?
Does tumor eterogeneity limit the use of the Weiss criteria in the evoluation
of adrenocortical tumours ?
• Adrenal incidentalomas larger than 6 cm with imaging features such as intratumoral necrosis suggestive of malignancy, should be manged as potential cancers independent of the so called Weiss criteria.
J Endocrinol Invest 2004 Jun;27 (6):565-9
AdrenalectomyAdrenalectomyIndications to laparoscopic approachIndications to laparoscopic approach
PheochromocytomaConn's adenomaNonfunctioning adenomaCarcinomaCushing's adenomaCushing's syndromeAngioMyolipomaMetastasisGanglioneuromaCyst
103 patients (3/95 - 8/3/05)
20
14
2965
87
7363 women, 40 menMean age: 49,8 years (range: 22-76)
4
Department of General Surgery
(Chief: Prof. Gianluigi Melotti)
Sant’Agostino Hospital
Modena, Italy
1995-200321 incidentalomi
15 femmine6 maschi
Età media 51,7(20-72 aa)
17 controlli3 dolori addominali
1 nefrolitiasi
Follow up in 7 casi(min 2 max 12 aa)
12dx 9 sin
7 adenomi 1 cisti vascolare
3 feocromocitomi2 pseudocisti
2 ganglioneuromi1 iperplasia nodulare
1 linfangioma cavernoso3 mielolipomi
1 metastasi
0
1
2
3
4
5
6
7
8
3,1-4 4,1-5 5,1-6 6,1-7 7,1-8 >10
n.casi
cm