Abstract：
BACKGROUND: The objective of this publication is to recall the initial work-up when faced with an adrenal incidentaloma and, if necessary, to establish the oncological management of an adrenal malignant tumor.
METHODS: The multidisciplinary working group updated French urological guidelines about oncological assessment of the adrenal incidentaloma, established by the CCAFU in 2020, based on an exhaustive literature review carried out on PubMed.
RESULTS: Although the majority of the adrenal masses are benign and non-functional, it is important to investigate them, as a percentage of these can cause serious endocrine diseases or be cancers. Malignant adrenal tumors are mainly represented by adrenocortical carcinomas (ACC), malignant pheochromocytomas (MPC) and adrenal metastases (AM). The malignancy assessment of an adrenal incident includes a complete history, a physical examination, a biochemical/hormonal assessment to look for subclinical hormonal secretion. Diagnostic hypotheses are sometimes available at this stage, but it is the morphological and functional imaging and the histological analysis, which will make it possible to close the malignancy assessment and make the oncological diagnosis.
CONCLUSIONS: ACC and MPC are mainly sporadic but a hereditary origin is always possible. ACC is suspected preoperatively but the diagnosis of certainty is histological. The diagnosis of MPC is more delicate and is based on clinic, biology and imagery. The diagnosis of certainty of AM requires a percutaneous biopsy. At the end, the files must be discussed within the COMETE - adrenal cancer network (Appendix 1).
METHODS: The multidisciplinary working group updated French urological guidelines about oncological assessment of the adrenal incidentaloma, established by the CCAFU in 2020, based on an exhaustive literature review carried out on PubMed.
RESULTS: Although the majority of the adrenal masses are benign and non-functional, it is important to investigate them, as a percentage of these can cause serious endocrine diseases or be cancers. Malignant adrenal tumors are mainly represented by adrenocortical carcinomas (ACC), malignant pheochromocytomas (MPC) and adrenal metastases (AM). The malignancy assessment of an adrenal incident includes a complete history, a physical examination, a biochemical/hormonal assessment to look for subclinical hormonal secretion. Diagnostic hypotheses are sometimes available at this stage, but it is the morphological and functional imaging and the histological analysis, which will make it possible to close the malignancy assessment and make the oncological diagnosis.
CONCLUSIONS: ACC and MPC are mainly sporadic but a hereditary origin is always possible. ACC is suspected preoperatively but the diagnosis of certainty is histological. The diagnosis of MPC is more delicate and is based on clinic, biology and imagery. The diagnosis of certainty of AM requires a percutaneous biopsy. At the end, the files must be discussed within the COMETE - adrenal cancer network (Appendix 1).
摘要：
背景：本出版物的目的是回顾面对肾上腺偶发瘤时的初步检查，如有必要,建立肾上腺恶性肿瘤的肿瘤学管理。
方法：多学科工作组更新了法国关于肾上腺偶发瘤肿瘤评估的泌尿外科指南，由CCAFU于2020年建立，基于在PubMed上进行的详尽文献综述。
结果：尽管大多数肾上腺肿块是良性和无功能的，调查他们很重要，作为这些可能导致严重的内分泌疾病或癌症的百分比。恶性肾上腺肿瘤主要表现为肾上腺皮质癌（ACC）。恶性嗜铬细胞瘤（MPC）和肾上腺转移（AM）。肾上腺事件的恶性评估包括完整的病史，体检,生化/激素评估以寻找亚临床激素分泌。诊断假设有时在这个阶段是可用的，但它是形态学和功能成像和组织学分析，这将有可能关闭恶性肿瘤评估并进行肿瘤诊断。
结论：ACC和MPC主要是零星的，但遗传起源总是可能的。术前怀疑ACC，但确定性的诊断是组织学上的。MPC的诊断更微妙，并且基于临床，生物学和图像。确定AM的诊断需要经皮活检。最后,这些文件必须在COMETE-肾上腺癌网络中进行讨论(附录1).
方法：多学科工作组更新了法国关于肾上腺偶发瘤肿瘤评估的泌尿外科指南，由CCAFU于2020年建立，基于在PubMed上进行的详尽文献综述。
结果：尽管大多数肾上腺肿块是良性和无功能的，调查他们很重要，作为这些可能导致严重的内分泌疾病或癌症的百分比。恶性肾上腺肿瘤主要表现为肾上腺皮质癌（ACC）。恶性嗜铬细胞瘤（MPC）和肾上腺转移（AM）。肾上腺事件的恶性评估包括完整的病史，体检,生化/激素评估以寻找亚临床激素分泌。诊断假设有时在这个阶段是可用的，但它是形态学和功能成像和组织学分析，这将有可能关闭恶性肿瘤评估并进行肿瘤诊断。
结论：ACC和MPC主要是零星的，但遗传起源总是可能的。术前怀疑ACC，但确定性的诊断是组织学上的。MPC的诊断更微妙，并且基于临床，生物学和图像。确定AM的诊断需要经皮活检。最后,这些文件必须在COMETE-肾上腺癌网络中进行讨论(附录1).
