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Algoritmo decisionale e terapeutico negli incidentalomi surrenalici Micaela Piccoli Divisione di Chirurgia Generale (Primario: Prof. Gianluigi Melotti)

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Presentation on theme: "Algoritmo decisionale e terapeutico negli incidentalomi surrenalici Micaela Piccoli Divisione di Chirurgia Generale (Primario: Prof. Gianluigi Melotti)"— Presentation transcript:

1 Algoritmo decisionale e terapeutico negli incidentalomi surrenalici Micaela Piccoli Divisione di Chirurgia Generale (Primario: Prof. Gianluigi Melotti) Ospedale SantAgostino Modena, Italia Scuola Speciale ACOI di Chirurgia laparoscopica e mini-invasiva (Direttore: Prof. Gianluigi Melotti) www.acoi.it XXIV CONGRESSO NAZIONALE ACOI 25/28 Maggio 2005 - Montecatini Terme

2 NIH Consensus and State-of-the Science Statements 2002, Feb 4-6;9(2);1-25 Management of the Clinically Inapparent Adrenal Mass Inapparent Adrenal Mass(Incidentaloma) Management of the Clinically Inapparent Adrenal Mass Inapparent Adrenal Mass(Incidentaloma)

3 Incidentaloma Ormonalmente attivo o non funzionante ? Benigno o maligno ? Se funzionante: surrenalectomia Se non funzionante: –> 6 cm surrenalectomia; –< 4 cm (senza sospetti nellimaging) monitoraggio –4-6 cm ?

4 Quale intervento? Controindicazioni allappproccio laparoscopico? Invasive adrenal carcinoma Malignant pheochromocytoma Size Infiltrating mass

5 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 adrenalectomy The size of the mass

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7 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

8 Adrenalectomy Indications to laparoscopic approach 103 patients (3/95 - 8/3/05) 20 14 29 6 5 8 7 7 3 63 women, 40 men Mean age: 49,8 years (range: 22-76) 4 Department of General Surgery (Chief: Prof. Gianluigi Melotti) SantAgostino Hospital Modena, Italy

9 1995-2003 21 incidentalomi 15 femmine 6 maschi Età media 51,7 (20-72 aa) 17 controlli 3 dolori addominali 1 nefrolitiasi Follow up in 7 casi (min 2 max 12 aa) 12dx 9 sin 7 adenomi 1 cisti vascolare 3 feocromocitomi 2 pseudocisti 2 ganglioneuromi 1 iperplasia nodulare 1 linfangioma cavernoso 3 mielolipomi 1 metastasi

10 cm


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