巨大無功能性腎上腺腫瘤之機器人手術處理及診斷挑戰

黃揚軒¹、王世鋒¹

¹國泰綜合醫院 外科部 泌尿科

Robotic Management of a 9.6 cm Non-Functional Adrenal Adenoma: A Diagnostic Dilemma

Yang-Hsuan Huang¹, Shih-Feng Wang¹

¹Division of Urology, Department of Surgery, Cathay General Hospital, Taipei City, Taiwan

The discovery of a large adrenal mass during the staging of an extra-adrenal malignancy presents a significant diagnostic challenge, as the clinical suspicion of metastasis often conflicts with the possibility of a primary adrenal tumor.

In this case, a 40-year-old female undergoing staging for cervical squamous cell carcinoma was found to have a massive 9.6 cm left adrenal mass on computed tomography (CT). Although the lesion's significant size and the context of a primary malignancy strongly raised the suspicion of metastatic disease or adrenocortical carcinoma, a comprehensive hormonal evaluation confirmed the tumor was non-functional. A CT-guided biopsy indicated a benign proliferation of adrenal cortical cells, but the result was considered inconclusive as the limited specimen could not definitively exclude malignancy or metastasis.

Following the patient’s concurrent chemoradiotherapy and staging surgery for cervical cancer, subsequent imaging showed the adrenal mass remained stable with no interval shrinkage. In light of the persistent diagnostic uncertainty and the high risk of malignancy inherent to a lesion of nearly 10 centimeters, the surgical team proceeded with a robotic-assisted left adrenalectomy. The procedure was successful and the final pathology report yielded a diagnosis of cortical adenoma, confirming the benign nature of the mass despite its suspicious clinical presentation.

This case highlights the remarkable utility of the robotic platform, which allowed for the safe and precise resection of a giant incidentaloma that traditionally might have mandated a more morbid open surgical approach. The final histopathological analysis represented a rare instance where a tumor of such extreme size did not harbor malignant features. This outcome underscores that robotic surgery is not only feasible but highly effective for the management of large adrenal tumors, providing a definitive diagnosis and treatment while minimizing patient recovery time even in the setting of complex oncologic staging.