Primary adrenal teratoma: A case series and review of the literature

  • Authors:
    • Liang Zhou
    • Xiang Pan
    • Tao He
    • Yulin Lai
    • Wenhua Li
    • Yiming Hu
    • Liangchao Ni
    • Shangqi Yang
    • Yun Chen
    • Yongqing Lai
  • View Affiliations

  • Published online on: August 1, 2018     https://doi.org/10.3892/mco.2018.1687
  • Pages: 437-442
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Abstract

Primary adrenal teratoma is a rare type of cancer. Of the 338 patients who underwent adrenalectomy during this study, only 2 (aged 69 and 29 years) were diagnosed with adrenal teratoma and underwent laparoscopic retroperitoneal adrenalectomy. For the purposes of the present study, the term ‘adrenal teratoma’ was searched in the PubMed database, and 237 articles published between June 1952 and March 2017 were retrieved. However, we were only able to identify 10 relevant studies. In total, these studies reported a series of 18 cases of primary adrenal teratoma in patients aged >16 years, another 8 cases of adult adrenal retroperitoneal teratoma, and 7 cases of adrenal teratoma in children aged <16 years. In the 18 cases aged >16 years, the age range was 17-61 years (mean ± standard deviation, 33.06±15.47 years), the median tumor diameter was 8.25 cm and 13 patients (72.22%) were female. Almost all patients underwent laparoscopic surgery between 2006 and 2017 (75%). Among the 7 cases of adrenal teratoma in children under the age of 16 years, 5 cases (71.43%) were male, the median tumor diameter was 10 cm, the oldest patient was aged 8 years, 5 cases (71.43%) were selected for open surgical resection of the tumor, and 5 cases (71.43%) were followed up without recurrence or death. These data indicate that primary adrenal teratomas in children are rarer compared with adults. Although the data are limited, it was observed that the clinical symptoms of primary adrenal teratoma are not typical, the preferred treatment is retroperitoneal laparoscopic surgery, and the prognosis is favorable. The aim of the present study was to elucidate the clinical characteristics associated with primary adrenal teratoma, in order to further raise awareness of this rare disease.

Introduction

Teratoma is a type of germ cell tumor, originating from pluripotent cells with multi-directional potential of differentiation into different types of somatic cells. The majority of teratomas contain more than one embryonic germ cell layer, mostly elements derived from ectoderm and least frequently from endoderm; therefore, teratomas may contain skin, hair, teeth, brain tissue, nerves, adipose tissue and cartilage, among others (1). Teratoma presenting outside the gonads is rare, while adrenal teratomas are even rarer. Teratomas are divided into mature and immature, according to the degree of tissue differentiation. Mature teratomas are benign, with a low malignant potential, although they may develop malignant transformation (2). Primary retroperitoneal teratomas are uncommon in patients aged >30 years, with only 10.0% of reported cases being over that age (3). The PubMed database was searched for the term ‘adrenal teratoma’, and 239 articles published between June 1952 and April 2017 were identified; however, only 10 of those articles were considered relevant to the present study. In total, these studies reported or described 18 cases of adult patients with primary adrenal teratomas (Table I), 7 cases of adrenal teratoma in children aged <16 years (Table II), and 8 cases of retroperitoneal teratoma of the adrenal gland (Table III). The purpose of this study was to review our experience with diagnosis and treatment of primary adrenal teratoma, in order to determine the clinical characteristics associated with this rare tumor.

Table I.

Cases of adult primary adrenal teratoma reported in the literature.

Table I.

Cases of adult primary adrenal teratoma reported in the literature.

CaseAge (years)YearSexPresentationLocationSize (cm)SurgeryFollow-up (months)(Refs.)
1171987MPainLeft8.0NANA(4)
2181999FBack painLeft11×8×7NANA(5)
3171999MBack pain for 2 monthsRight7.5×6×3NANA(5)
4371999FBack pain for 1 yearLeft10NANA(5)
5572002FAbdominal pain for 6 monthsLeft8.0×7.0×5.0NANA(3)
6212004FIncreased abdominal massLeft38×30×30NANA(6)
7612006FIncidental discoveryLeft8.0Laparoscopic12(7)
8402010FPainRight9×8×5OpenNA(8)
9492015MIncidental discoveryRight6.0×7.0×11 Retroperitoneoscopic8(9)
10212015FIncidental discoveryRight8.5 Retroperitoneoscopic4–60(10)
11162015FIncidental discoveryRight9.0 Retroperitoneoscopic4–60(10)
12432015FIncidental discoveryLeft4.9 Retroperitoneoscopic4–60(10)
13492015FIncidental discoveryLeft5.3 Retroperitoneoscopic4–60(10)
14512015FIncidental discoveryRight2.4 Retroperitoneoscopic4–60(10)
15192015MFlank pain for 9 monthsRight8×6×4Open12(11)
16262017MFlank painRight8.5×5.5×4.8OpenNA(12)
17292017FIncidental discoveryLeft2.5×2.1×0.5LaparoscopicNA(12)
18242017FAbdominal painLeft11.5×9.0×3LaparoscopicNA(12)

[i] M, male; F, female; NA, not available.

Table II.

Pediatric cases of adrenal teratoma reported in the literature.

Table II.

Pediatric cases of adrenal teratoma reported in the literature.

CaseAgeYearSexPresentationLocationSize (cm)SurgeryFollow-up (months)(Refs.)
15 years1968MIncidental discoveryRight10×7.5×3.5Open6(13)
28 years2006MLumbar pain after a fallRight8.0Laparoscopic3(7)
345 days2009MIncidental discoveryLeft5.5×4.5×3Open12(14)
44 years2011FIncidental discoveryLeft3.0Open13(15)
58 years2011MAbdominal painRight10×8×6Open6(16)
63 months2013MAbdominal distensionLeft14×10×8NANA(17)
73 months2017FAbdominal distentionRight10×10×8OpenNA(18)

[i] M, male; F, female; NA, not available.

Table III.

Cases of retroperitoneal adrenal teratoma reported in the literature.

Table III.

Cases of retroperitoneal adrenal teratoma reported in the literature.

CaseAge (years)YearSexPresentationLocationSize (cm)SurgeryFollow-up (months)(Refs.)
1332007MIncidental discoveryLeft9×7×5Open18(19)
2372010MAccidental discoveryLeft20×14×13Laparoscopic4(20)
3502011FBack pain for 2 yearsLeft8×4×3.5Laparoscopic18(21)
4622011MIncidental discoveryLeft4.7×3.0Laparoscopic48(22)
5222013MFlank pain for 1monthLeft9.0×9.0×10NA6(23)
6392014FDizziness for 6 monthsRight22.5×17×7NA18(24)
7242016FPain and coughing for 2 yearsLeft7.6×3×6.5NANA(25)
8322016FIncidental discoveryRight5.1×3.6×3.4 Retroperitoneoscopic29(26)

[i] M, male; F, female; NA, not available.

Case reports

Case 1

A mass in the left abdomen developing for 3 months was identified in a 69-year-old female patient who was admitted to the hospital for further examination and treatment. No other physical findings were observed. Computed tomography (CT) examination after admission revealed a spindle-shaped mass of heterogeneous density in the left adrenal gland, consisting mainly of fat tissue; a small number of calcifications and soft tissue density shadows were visible. The mass was sized ~9.3×4.9 cm (Fig. 1). The results of complete blood counts and routine biochemical assessment, including kidney and liver function tests, revealed no major abnormalities. The test results for serum cortisol, adrenocorticotropic hormone, renin-angiotensin-aldosterone, plasma epinephrine, plasma norepinephrine, plasma dopamine and urinary vanillylmandelic acid were unremarkable. Therefore, the clinical diagnosis was left adrenal mass. Subsequent retroperitoneal left adrenal lumpectomy was successfully performed. After the tumor was completely removed, gross postoperative examination revealed a grayish-yellow mass, sized 10.0×6.0×4.0 cm, including visible gray cartilage tissue and bone-like hard tissue. Hematoxylin and eosin (H&E) staining was conducted as follows: The tissue was fixed using a 10% formalin solution at 37°C for 24 h. Sections were cut to 6–8 µm thickness then dried in an incubator at 45°C. Subsequently, sections were stained with hematoxylin for 15 min (37°C), rinsed under running water for 1 min then left standing in water for 5 min. Staining with 0.5% eosin was also conducted for 3 min (37°C), followed by a rinse under running water. Under examination with an optical microscope, the tumor included adipose tissue, cartilage, calcification, ossification and smooth muscle. Tubular structures with stratified epithelium, with no obvious mitotic figures, were regionally identified, and were surrounded by fiber and smooth muscle. The tumor was infiltrated by inflammatory cells, and included scattered tubular and vesicular structures lined by ciliated columnar epithelium or flattened epithelium (Fig. 2). Based on these findings, the pathological analysis of the specimens from the left adrenal gland suggested the diagnosis of teratoma. The patient was stable, did not complain of pain postoperatively, and exhibited no recurrence at the 1-year follow-up.

Case 2

An asymptomatic 29-year-old woman was admitted to the hospital due to incidental discovery of a left adrenal mass 1 month prior. A CT examination after admission revealed an irregular pelvic lesion, sized 6.0×4.0 cm, in the lower part of the left adrenal gland (Fig. 3). Calcification was identified at the edge of the tumor. Routine blood examinations, such as liver and kidney function tests, electrolytes and other routine tests, revealed no major abnormalities. Plasma adrenal-associated hormone levels, adrenocorticotropic hormone, renin activity, angiotensin, aldosterone, cortisol, and urine vanillylmandelic acid levels were within the normal range. Thus, the clinical diagnosis was left adrenal gland mass. Subsequently, complete laparoscopic retroperitoneal adrenalectomy was successfully performed. Macroscopic examination of the sample revealed a grayish-red mass, sized 2.5×2.1×0.5 cm, of mixed consistency. The capsule of the mass was gray and solid. H&E staining was conducted as aforementioned. Microscopic examination revealed a tumor cyst wall lined with squamous epithelium, and cartilage was also identified (Fig. 4). Based on these findings, the pathological analysis of the specimens from the left adrenal gland suggested the diagnosis of mature teratoma. The patient was stable postoperatively and no recurrence had occurred at the 12-month follow-up.

Results

A total of 18 cases of definitive adult primary adrenal teratomain patients aged 17–61 years [mean ± standard deviation (SD); 33.06±15.47 years] were identified in the literature. Of the 18 patients, 13 were female (72.22%). A total of 8 patients (44.44%) visited a doctor after they incidentally found an adrenal mass, and 7 patients (38.89%) visited a doctor due to abdominal or back pain. Of the 18 patients, 9 (50%) experienced pain, and teratoma was found in the left adrenal gland in 9 patients (50%). The median diameter of the tumor was 8.25 cm. The majority of the patients consented to laparoscopic surgery between 2006 and 2017 (75%). Definitive follow-up data suggesting a good prognosis were only reported for8 of the cases (44.44%).

Among patients aged <16 years, 7 pediatric cases of adrenal teratoma were reported in the literature, of whom were 5 male (71.43%). A total of 3 cases (42.86%) were incidentally found during examination, 2 cases (28.57%) visited a doctor due to pain, and 2 cases (28.57%) visited a doctor due to abdominal distension. The median tumor diameter was 10 cm. The oldest pediatric patient was aged 8 years. Only 1 patient underwent laparoscopic tumor resection, and there was no reported disease recurrence or death during the follow-up period in 5 patients.

Due to the rarity of teratoma, there is no clear clinical or pathological definition for this condition (3). It remains to be determined whether primary adrenal teratoma should be considered as a pathological entity similar to other retroperitoneal teratomas. According to its definition, primary retroperitoneal teratoma is not specific to any organ, and is most common in the left adrenal region. The present research also identified 8 cases of adult adrenal gland retroperitoneal teratomas (4 male and 4 female patients). These patients were aged 24–62 years (mean ± SD; 37.38±13.27 years). Four of the patients were admitted to the hospital due toan incidentally discoveredadrenal mass, and in 6 cases (75%) the mass was located in the left adrenal gland. The median tumor diameter was 8.5 cm. The tumors were successfully removed laparoscopicallyin 4 cases (50%). Complete follow-up data were available for 7 cases (87.5%), and they all had a good prognosis. There was 1 reported death due to hypertension (24).

Discussion

Adrenal mature teratomas are generally non-functional, and the tumor exhibits latent growth. During the early stages, the tumor causes no signs or symptoms. Later, as the tumor increases in size, it may press on the surrounding organs, which may cause abdominal discomfort and distension, lumbago, back pain, nausea, vomiting, weight loss, urinary retention, intestinal obstruction, even swelling of the lower extremity or genitals due to lymphatic obstruction. There is no specificity regarding the organs affected by this tumor or the symptoms. For example, when a cystic teratoma ruptures, patients may suddenly experience abdominal pain, peritoneal effusion or peritonitis (1), while other patients remain asymptomatic (2).

B-scan ultrasound, CT and magnetic resonance imaging (MRI) can clearly demonstrate the location, shap, and anatomical associations of the tumor. Tumors on B-scan appear as a heterogeneous group of strong light signals and contained a variety of cystic/solid elements with uneven echo, reflecting the tumor tissue composition. However, this qualitative diagnosis is not sufficient. The appearance of teratoma on CT is quite characteristic, and its diagnostic accuracy is superior to that with B-ultrasound. CT images of mature teratoma reveal the presence of calcification and adipose tissue, the growth site of the tumor is clear, the capsule is continuous with the surrounding tissues and organs, and the presence of infiltration and invasive growth can be determined. This level of clarity is useful for providing the basis for preoperative assessment and selection of the surgical method (27). MRI can demonstrate the internal characteristics of the tumor and the location of tumor blood vessels, improve the resolution of soft tissue, clearly delineate the border between the tumor capsule and the surrounding adipose tissue, and determine the association between the teratoma and major blood vessels and the presence of infiltration (1). Therefore, the results of preoperative imaging and postoperative pathology are crucial for the final diagnosis of teratoma.

Adrenal teratoma is usually treated by surgical resection. The goal is complete removal of the tumor without damaging adjacent tissues and organs, in order to relieve the clinical symptoms and prevent malignant transformation (28). In addition, if the tumor can be completely resected, a biopsy is not considered necessary. Teratomas are not sensitive to radiotherapy or chemotherapy. The surgical procedure is complicated, as adrenal mature teratoma is often closely associated or wrapped around important blood vessels with thin walls; this makes complete resection exceedingly difficult. If necessary, the complicating blood vessels should be severed and then ligated. In general, mature teratoma exhibits a high degree of tissue differentiation (29). Complete resection is usually curative, with only few reported cases of recurrence and metastasis (30). A completely resected benign teratoma may not require adjuvant chemotherapy, as it has been reported that mature adrenal teratomas have been successfully resected in patients as young as 8 and as old as61 years. Both patients recovered well, with no recurrence (7).

At present, laparoscopic surgery remains the primary choice for the treatment of adrenal tumors. Laparoscopic techniques have been used in adrenal surgery since 1992, have developed rapidly and are increasingly being used in urology (31). Due to the small incision and fast recovery, laparoscopic surgery has become the preferred treatment method for mature adrenal teratomas. Laparoscopic surgery is currently the gold standard for the removal of adrenal lesions (32).

Pediatric adrenal teratomas are uncommon, representing~5% of all pediatric teratomas (12). Although pediatric cases of adrenal teratomas have not been found in our literature review, primary adrenal teratomas have been reported in neonates, infants and children. Interestingly, primary adrenal teratoma has been reported to have a maximum onset age of 8 years, with no reports in the literature of such tumors in older children.

In conclusion, primary adrenal teratoma is a rare tumor, which is more common in adults compared with children. Adult primary adrenal teratoma occurs more often in men; however, among pediatric cases, there were more female compared with male patients. In both adults and children, adrenal primary adrenal teratoma usually manifests as a large adrenal mass, preoperative diagnosis is difficult, and diagnosis can only be confirmed by histopathological examination following surgical removal of the tumor. Laparoscopic surgery is the primary treatment choice for adult adrenal teratoma, but children with primary adrenal teratoma usually undergo open surgery. Based on the available follow-up data, adults and children with primary adrenal teratoma have a good prognosis with treatment. Due to the limited number of cases reported in the literature, the current results are not comprehensive. More studies and clinical cases of teratoma with long-term follow-up data must be published and analyzed to confirm these trends.

Acknowledgements

Not applicable.

Funding

The present study was supported by the National Natural Science Foundation of China (grant no. 81101922), Science and Technology Development Fund Project of Shenzhen (grant nos. JCYJ20160429090753103 and JCYJ20170307111334308), the fund of ‘San-ming’ Project of Medicine in Shenzhen (grant no. SZSM201612066), the Fund of Shenzhen Key Laboratory (grant no. ZDSYS201504301045406) and the fund of Guangdong Key Medical Subject.

Availability of data and materials

The analyzed data sets generated during the study are available from the corresponding author on reasonable request.

Authors' contributions

LZ and XP performed the experimental work, data collection and interpretation. TH and YL participated in the design and coordination of experimental work, and acquisition of data. WL, YH, LN and SY participated in the study design, data collection, analysis of data and preparation of the manuscript. YL conducted the study design, the analysis and interpretation of data and drafted the manuscript. All authors read and approved the final manuscript.

Ethics approval and consent to participate

Consent to participate was obtained from all patients.

Consent for publication

Consent for publication of any associated data and accompanying images was obtained from all patients.

Competing interests

The authors declare that they have no competing interests.

References

1 

Scott AL, Abbassi-Ghadi N, Archer CM, Swamy R and Gupta S: Neuroendocrine carcinoma arising within a retroperitoneal mature teratoma. Ann R Coll Surg Engl. 92:W5–W8. 2010. View Article : Google Scholar : PubMed/NCBI

2 

Gatcombe HG, Assikis V, Kooby D and Johnstone PA: Primary retroperitoneal teratomas: A review of the literature. J Surg Oncol. 86:107–113. 2004. View Article : Google Scholar : PubMed/NCBI

3 

Bedri S, Erfanian K, Schwaitzberg S and Tischler AS: Mature cystic teratoma involving adrenal gland. Endocr Pathol. 13:59–64. 2002. View Article : Google Scholar : PubMed/NCBI

4 

McMillan A and Horwich A: Malignant teratoma presenting with an adrenal mass. Clin Radiol. 38:327–328. 1987. View Article : Google Scholar : PubMed/NCBI

5 

Lam KY and Lo CY: Teratoma in the region of adrenal gland: A unique entity masquerading as lipomatous adrenal tumor. Surgery. 126:90–94. 1999. View Article : Google Scholar : PubMed/NCBI

6 

Polo JL, Villarejo PJ, Molina M, Yuste P, Menéndez JM, Babé J and Puente S: Giant mature cystic teratoma of the adrenal region. AJR Am J Roentgenol. 183:837–838. 2004. View Article : Google Scholar : PubMed/NCBI

7 

Castillo OA, Vitagliano G, Villeta M, Arellano L and Santis O: Laparoscopic resection of adrenal teratoma. JSLS. 10:522–524. 2006.PubMed/NCBI

8 

Shrestha MK and Lalchan S: Adrenal gland teratoma in a 40-year-old woman. Nepal Med Coll J. 12:201–202. 2010.PubMed/NCBI

9 

Li H, Zhao T, Wei Q, Yuan H, Cao D, Shen P, Liu L, Zeng H and Chen N: Laparoscopic resection of a huge mature cystic teratoma of the right adrenal gland through retroperitoneal approach: A case report and literature review. World J Surg Oncol. 13:3182015. View Article : Google Scholar : PubMed/NCBI

10 

Li S, Li H, Ji Z, Yan W and Zhang Y: Primary adrenal teratoma: Clinical characteristics and retroperitoneal laparoscopic resection in five adults. Oncol Lett. 10:2865–2870. 2015. View Article : Google Scholar : PubMed/NCBI

11 

Nadeem M, Ather MH, Sulaiman MN and Pervez S: ‘Looks Can Be Deceiving’: Adrenal Teratoma Causing Diagnostic Difficulty. Case Rep Urol. 2015:2325912015.PubMed/NCBI

12 

Kuo EJ, Sisk AE, Yang Z, Huang J, Yeh MW and Livhits MJ: Adrenal Teratoma: A Case Series and Review of the Literature. Endocr Pathol. 28:152–158. 2017. View Article : Google Scholar : PubMed/NCBI

13 

Engel RM, Elkins RC and Fletcher BD: Retroperitoneal teratoma. Review of the literature and presentation of an unusual case. Cancer. 22:1068–1073. 1968. View Article : Google Scholar : PubMed/NCBI

14 

Oguzkurt P, Ince E, Temiz A, Demir S, Akabolat F and Hicsonmez A: Prenatal diagnosis of a mass in the adrenal region that proved to be a teratoma. J Pediatr Hematol Oncol. 31:350–351. 2009. View Article : Google Scholar : PubMed/NCBI

15 

Li Y, Zhong Z and Zhao X: Primary mature teratoma presenting as an adrenal tumor in a child. Urology. 78:689–691. 2011. View Article : Google Scholar : PubMed/NCBI

16 

Ersoz S, Kucuk H, Mungan S, Turgutalp H, Imamoglu M and Kosucu P: Neurocytoma arising in an adrenal gland mature teratoma. Fetal Pediatr Pathol. 30:275–279. 2011. View Article : Google Scholar : PubMed/NCBI

17 

Ciftci I, Cihan T, Koksal Y, Ugras S and Erol C: Giant mature adrenal cystic teratoma in an infant. Acta Inform Med. 21:140–141. 2013. View Article : Google Scholar : PubMed/NCBI

18 

Garg A, Pollak-Christian E and Unnikrishnan N: A Rare Adrenal Mass in a 3-Month-Old: A Case Report and Literature Review. Case Rep Pediatr. 2017:45423212017.PubMed/NCBI

19 

Rais-Bahrami S, Varkarakis IM, Lujan G and Jarrett TW: Primary retroperitoneal teratoma presenting as an adrenal tumor in an adult. Urology. 69(185): e181–e182. 2007.

20 

Sato F, Mimata H and Mori K: Primary retroperitoneal mature cystic teratoma presenting as an adrenal tumor in an adult. Int J Urol. 17:8172010. View Article : Google Scholar : PubMed/NCBI

21 

Chen JC, Khiyami A and McHenry CR: Retroperitoneal cystic teratoma masquerading as an incidentally discovered adrenal mass. Endocr Pract. 17:e130–e134. 2011. View Article : Google Scholar : PubMed/NCBI

22 

Giordano R, Giraudo G, Forno D, Bosco M, Delsedime L, Morino M and Arvat E: A case of primary retroperitoneal teratoma presenting as an adrenal incidentaloma. J Endocrinol Invest. 34:645–646. 2011. View Article : Google Scholar : PubMed/NCBI

23 

Bhatti A, Al-Hindi H, Azzam A, Amin T and Abu-Zaid A: Mature (benign) cystic retroperitoneal teratoma involving the left adrenal gland in a 22-year-old male: A case report and literature review. Case Rep Oncol Med. 2013:6102802013.PubMed/NCBI

24 

Tang DD, Zhang XS, Hao ZY, Zhou J and Liang CZ: A giant primary retroperitoneal mature cystic teratoma in right adrenal region in a 39-year-old female. Int J Clin Exp Med. 7:1611–1613. 2014.PubMed/NCBI

25 

Bhatia V, Sharma S, Sood S, Mardi K and Venkat B: Case 231: Retroperitoneal Adrenal Teratoma Presenting as Trichoptysis. Radiology. 280:317–321. 2016. View Article : Google Scholar : PubMed/NCBI

26 

Kataoka M, Fukushima H, Nakanishi Y, Yokoyama M, Funata N, Motoi T, Tobisu KI and Koga F: Retroperitoneal Teratoma in an Adult: A Potential Pitfall in the Differential Diagnosis of Adrenal Myelolipoma. Case Rep Urol. 2016:51417692016.PubMed/NCBI

27 

Wang LJ, Chu SH, Ng KF and Wong YC: Adenocarcinomas arising from primary retroperitoneal mature teratomas: CT and MR imaging. Eur Radiol. 12:1546–1549. 2002. View Article : Google Scholar : PubMed/NCBI

28 

Yoon SS, Tanabe KK and Warshaw AL: Adult primary retroperitoneal teratoma. Surgery. 137:663–664. 2005. View Article : Google Scholar : PubMed/NCBI

29 

Jones NM and Kiely EM: Retroperitoneal teratomas-potential for surgical misadventure. J Pediatr Surg. 43:184–186; discussion 187. 2008. View Article : Google Scholar : PubMed/NCBI

30 

James J, Dhillon GS, Blewett CJ, Halldorsson A and Cecalupo AJ: A large adrenal teratoma in a neonate. Am Surg. 75:347–349. 2009.PubMed/NCBI

31 

Gagner M, Lacroix A and Bolté E: Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med. 327:10331992. View Article : Google Scholar : PubMed/NCBI

32 

Chuan-Yu S, Yat-Faat H, Wei-Hong D, Yuan-Cheng G, Qing-Feng H, Ke X, Bin G and Guo-Wei X: Laparoscopic adrenalectomy for adrenal tumors. Int J Endocrinol. 2014:2418542014. View Article : Google Scholar : PubMed/NCBI

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APA
Zhou, L., Pan, X., He, T., Lai, Y., Li, W., Hu, Y. ... Lai, Y. (2018). Primary adrenal teratoma: A case series and review of the literature. Molecular and Clinical Oncology, 9, 437-442. https://doi.org/10.3892/mco.2018.1687
MLA
Zhou, L., Pan, X., He, T., Lai, Y., Li, W., Hu, Y., Ni, L., Yang, S., Chen, Y., Lai, Y."Primary adrenal teratoma: A case series and review of the literature". Molecular and Clinical Oncology 9.4 (2018): 437-442.
Chicago
Zhou, L., Pan, X., He, T., Lai, Y., Li, W., Hu, Y., Ni, L., Yang, S., Chen, Y., Lai, Y."Primary adrenal teratoma: A case series and review of the literature". Molecular and Clinical Oncology 9, no. 4 (2018): 437-442. https://doi.org/10.3892/mco.2018.1687