[Cysts of the adrenal gland].

Cysts of the adrenal gland are extremely uncommon and despite diligent search in the literature, only fifty recorded cases have been found. Some of the cysts have been of clinical significance but many have been discovered accidentally during the course of a laparotomy for some unrelated condition or at autopsy. Relatively few have been removed surgically and in only one instance has a correct pre-operative diagnosis been made. (Levison I933.) The first recorded case is that of Greiselius of Vienna in I670 (Doran I907). At a routine autopsy a very large cystic swelling was found apparently arising above the upper pole of the left kidney. The cyst had ruptured and more than a gallon of blood-stained fluid and clot was found free within the peritoneal cavity. The haemorrhage following the rupture appeared to have been responsible for death. The next case was not reported for over I6o years, until Rayer in I837 described a haemorrhagic cyst of the right adrenal bodyweighing about 4 lb. Between I865 and I9o6, six further cases were presented before the Pathological Society in London and the same number of cases were described in European medical literature. These cysts varied in size from a marble (Ogle i865) up to an enormous cyst containing 17 pints of altered blood which was successfully removed surgically, with recovery of the patient (Pawlick I898). During this period a case was described of a serious cyst in the cerebellum (Turner i888). Two cases of a cyst-adenoma were described (Crawford I899; Rolleston i899), and the first cases of lymphangiectasis of the adrenal associated with one or more larger cysts were also reported (Obendorfer' Igo; Marchetti I903; Bossard I906). The first attempt to classify the various cystic swellings of the adrenal was made by Henshaw in I906, when he reviewed the literature and reported a fresh case. This classification with minor alterations is still applicable. Classification of Adrenal Cysts