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Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Right Adrenal Masses

Report of 2 Cases

Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana USA.

Address correspondence to John M. DeWitt, MD, Department of Medicine, Division of Gastroenterology, Indiana University Medical Center, 550 N University Blvd, UH 4100, Indianapolis, IN 46202-5121 USA. E-mail: jodewitt{at}iupui.edu

Objective. Although transgastric endoscopic ultrasound (EUS)-guided biopsy is a safe and accurate method for sampling of the left adrenal gland, only 2 reports describing EUS-guided fine-needle aspiration (FNA) of the right adrenal gland have been published to date. The aim of this series was to report 2 additional successful cases of EUS-FNA of right adrenal masses. Methods. In this retrospective single-center case series, prospectively updated cytology and EUS databases between January 1997 and September 2007 were reviewed to identify all patients who underwent attempted EUS-FNA of either adrenal gland. Those who underwent EUS-FNA of the right adrenal gland were identified and reviewed. Results. Of 52 consecutive patients who underwent EUS-FNA of either adrenal gland, 2 had attempted biopsy of the right adrenal gland and constituted the study population. The first patient had a history of colon cancer and was found to have a right adrenal mass during workup of jaundice. The second patient also had a history of colon cancer and was found to have an enlarging right adrenal mass and a subcarinal mass during follow-up computed tomography. Endoscopic ultrasound-guided FNA showed a pheochromocytoma in the first patient and metastatic colon cancer in the second patient. No complications were encountered during either procedure. Conclusions. This series further shows that EUS-FNA of right adrenal masses is feasible and may be an option for sampling of these lesions. Prospective studies comparing EUS with percutaneous FNA of adrenal masses are indicated to help delineate the indications and limitations of each technique.

Key Words: adrenal gland • endoscopic ultrasound • fine-needle aspiration

Abbreviations: CT, computed tomography • EUS, endoscopic ultrasound • FNA, fine-needle aspiration