The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
A Consideration on Surgical Indication
Makoto HataHitoshi YanaiharaKunihiro HayakawaMasakazu OhashiHiromichi IshikawaKen NakagawaHiroshi Tazaki
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1994 Volume 85 Issue 6 Pages 974-980


At our medical center we have seen 151 patients who have undergone adrenalectomy from 1971 up until June 1992. There has been a recent increase in the number of cases since 99 patients have been seen in the last eight years from 1985. This increase is related to the increase in the number of incidental tumors. Of those 99, 26 have been incidental tumors. Twenty-four of those have been endocrine inactive tumors, and the remaining 2, both active endocrinologically, were pheochromocytoma.
We propose that our tentative indications for surgical treatment of incidental tumors are 1) tumors of diameter 3.5cm or greater, 2) tumors undeniably malignant by imaging diagnosis, 3) tumors that tend to increase in size with every six-month re-examination, even though the original size is less than 3.5cm in diameter, and 4) tumors endocrinologically active.
The main purpose of this study was to make a differential diagnosis of malignant tumors among incidental tumors. Diagnostic modalities included 1) imaging diagnosis such as echography, CT, MRI, and angiography, 2) analysis of DNA ploidy and BrdU uptake utilizing flow cytometry of excised adrenal tumor tissues, and 3) analysis of urinary steroid fraction.
It is generally thought that there are currently no methods by which malignant tumors can be differentiated with certainty, even with modern diagnostic technology, and review of the literture, finds approval or disapproval with regard to the methods we selected to evaluate tumors. What has aroused interest in our results is urinary 17KS fraction. Cases of canser exhibiting high values are limited to the fraction in which the 5-hydroxyl group of the steroid nucleus is in β-position. Although the number of cases is still small, it is our hope this finding will provide a clue to establish useful method for the differential diagnosis.

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