{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T08:15:06Z","timestamp":1788423306249,"version":"build-2803163510"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012659","name":"Foundation for Innovative Research Groups of the National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81960148"],"award-info":[{"award-number":["81960148"]}],"id":[{"id":"10.13039\/501100012659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Adrenal cysts are relatively rare, and most are nonfunctional and lack specific clinical manifestations, often being discovered incidentally during imaging examinations. For giant adrenal cysts with a maximum diameter exceeding 10\u2005cm, especially when accompanied by degenerative changes such as hemorrhage, fibrosis, and calcification, compression of adjacent organs and obscuration of anatomical planes may increase the difficulty of determining the origin preoperatively, and they may even be misdiagnosed as pancreatic, renal, or other retroperitoneal cystic lesions. This article reports one case of a giant adrenal pseudocyst with unclear origin before surgery and discusses its diagnostic and surgical management strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case report<\/jats:title>\n                    <jats:p>A 36-year-old woman was admitted after a left retroperitoneal mass was incidentally discovered during trauma evaluation one month earlier. Contrast-enhanced CT showed a cystic low-density lesion measuring approximately 108\u2005mm\u2009\u00d7\u2009102\u2005mm\u2009\u00d7\u2009108\u2005mm in the left retroperitoneal space, with marginal calcification. The left adrenal gland was not distinctly identified, and the lesion was closely related to the stomach, spleen, and pancreas. The organ of origin remained uncertain preoperatively, with cystic lesions of adrenal, pancreatic, or gastric origin considered in the differential diagnosis. After multidisciplinary discussion, laparoscopic resection was performed. Intraoperatively, the lesion was densely adherent to surrounding organs and its origin was difficult to determine; resection was completed after decompression, and the residual cyst wall on the splenic side was treated with electrocautery. Postoperative pathology confirmed a left adrenal pseudocyst with calcification. The patient recovered smoothly, and no complications were observed during follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Giant complex adrenal pseudocysts may mimic other left retroperitoneal cystic lesions, and the diagnostic difficulty lies in determining the organ of origin. For giant retroperitoneal cystic lesions of unclear origin, adrenal origin should be included as an important differential diagnosis, and comprehensive decisions should be made based on imaging, endocrine evaluation, and multidisciplinary discussion; if no safe dissection plane exists intraoperatively, individualized management should be implemented.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1883619","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:48:00Z","timestamp":1788421680000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Giant adrenal pseudocyst with unclear preoperative origin: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Shouyi","family":"Long","sequence":"first","affiliation":[{"name":"Department of Urology, Renhuai Traditional Chinese Medicine Hospital","place":["Renhuai, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Urology, Renhuai Traditional Chinese Medicine Hospital","place":["Renhuai, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Urology, Renhuai Traditional Chinese Medicine Hospital","place":["Renhuai, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Urology, Renhuai Traditional Chinese Medicine Hospital","place":["Renhuai, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiujun","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Urology, Renhuai Traditional Chinese Medicine Hospital","place":["Renhuai, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shulian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Urology, Affiliated Hospital of Zunyi Medical University","place":["Zunyi, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1530\/eje-22-0285","article-title":"Clinical course and imaging characteristics of benign adrenal cysts: a single-center study of 92 patients","volume":"187","author":"Dogra","year":"2022","journal-title":"Eur J Endocrinol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"846","DOI":"10.3390\/jcm13030846","article-title":"Adrenal cysts: to operate or not to operate?","volume":"13","author":"Bozic Antic","year":"2024","journal-title":"J Clin Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"201","DOI":"10.4132\/jptm.2024.06.07","article-title":"What's new in adrenal gland pathology: WHO 5th edition for adrenal cortex","volume":"58","author":"Rizkalla","year":"2024","journal-title":"J Pathol Transl Med"},{"key":"B4","first-page":"744","article-title":"Giant adrenal cyst: management and review of the literature","volume":"63","author":"Tagge","year":"1997","journal-title":"Am Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"8841","DOI":"10.1186\/1757-1626-0002-0000008841","article-title":"Giant adrenal endothelial cyst associated with acute and chronic morbidity in a young female: a case report","volume":"2","author":"Khan","year":"2009","journal-title":"Cases J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e1314","DOI":"10.1002\/cnr2.1314","article-title":"Cystic adrenal lesions: a report of five cases","volume":"4","author":"Goel","year":"2021","journal-title":"Cancer Rep (Hoboken)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13244-019-0688-8","article-title":"Imaging features of adrenal masses","volume":"10","author":"Albano","year":"2019","journal-title":"Insights Imaging"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e254535","DOI":"10.1136\/bcr-2022-254535","article-title":"Cystic lesions of the adrenal gland","volume":"16","author":"Solanki","year":"2023","journal-title":"BMJ Case Rep"},{"key":"B9","doi-asserted-by":"publisher","first-page":"E1109","DOI":"10.1055\/a-0658-1389","article-title":"Large adrenal cyst masquerading as a pancreatic cystic tumor: a rare diagnosis based on endoscopic ultrasound","volume":"6","author":"Voudoukis","year":"2018","journal-title":"Endosc Int Open"},{"key":"B10","doi-asserted-by":"publisher","first-page":"548","DOI":"10.3892\/ol.2025.15294","article-title":"Adrenal cyst misdiagnosed with cystic renal cell carcinoma: a case report","volume":"30","author":"Huang","year":"2025","journal-title":"Oncol Lett"},{"key":"B11","doi-asserted-by":"publisher","first-page":"333","DOI":"10.12659\/ajcr.893798","article-title":"All those liver masses are not necessarily from the liver: a case of a giant adrenal pseudocyst mimicking a hepatic cyst","volume":"16","author":"Patnaik","year":"2015","journal-title":"Am J Case Rep"},{"key":"B12","doi-asserted-by":"publisher","first-page":"150457","DOI":"10.1155\/2013\/150457","article-title":"Adrenal cyst presenting as hepatic hydatid cyst","volume":"2013","author":"Darwish","year":"2013","journal-title":"Case Rep Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"G1","DOI":"10.1093\/ejendo\/lvad066","article-title":"European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors","volume":"189","author":"Fassnacht","year":"2023","journal-title":"Eur J Endocrinol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.1002\/ccr3.1519","article-title":"A giant adrenal cyst with an uncertain preoperative diagnosis causing a dilemma in management","volume":"6","author":"Olaoye","year":"2018","journal-title":"Clin Case Rep"},{"key":"B15","first-page":"474","article-title":"Giant adrenal pseudocyst mimicking a malignant lesion","volume":"46","author":"Mohan","year":"2003","journal-title":"Can J Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1007\/s11255-005-3422-z","article-title":"A giant adrenal pseudocyst: case report and review of the literature","volume":"38","author":"Demir","year":"2006","journal-title":"Int Urol Nephrol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/j.ijscr.2011.10.002","article-title":"Adrenal pseudocyst: diagnosis and laparoscopic management - A case report","volume":"2","author":"Ujam","year":"2011","journal-title":"Int J Surg Case Rep"},{"key":"B18","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1159\/000346754","article-title":"A giant adrenal pseudocyst mimicking an adrenal cancer: case report and review of the literature","volume":"91","author":"Passoni","year":"2013","journal-title":"Urol Int"},{"key":"B19","doi-asserted-by":"publisher","first-page":"8473231","DOI":"10.1155\/2018\/8473231","article-title":"Surgical management of a giant adrenal pseudocyst: a case report and review of the literature in the last decade","volume":"2018","author":"Paramythiotis","year":"2018","journal-title":"Case Rep Surg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e251114","DOI":"10.1136\/bcr-2022-251114","article-title":"Laparoscopic excision of a large adrenal pseudocyst: diagnostic dilemma and technical challenges","volume":"15","author":"Shettar","year":"2022","journal-title":"BMJ Case Rep"},{"key":"B21","doi-asserted-by":"publisher","first-page":"16669","DOI":"10.20452\/pamw.16669","article-title":"A giant hemorrhagic adrenal pseudocyst as a cause of a diagnostic dilemma","volume":"134","author":"Bobkiewicz","year":"2024","journal-title":"Pol Arch Intern Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1007\/s00330-002-1537-5","article-title":"Imaging spectrum of adrenal pseudocysts on CT","volume":"13","author":"Wang","year":"2003","journal-title":"Eur Radiol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1148\/radiology.201.2.8888255","article-title":"Cystic adrenal lesions: CT features","volume":"201","author":"Rozenblit","year":"1996","journal-title":"Radiology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1148\/rg.210056","article-title":"Pancreatic cystic lesions and malignancy: assessment, guidelines, and the field defect","volume":"42","author":"Miller","year":"2022","journal-title":"Radiographics"},{"key":"B25","doi-asserted-by":"publisher","first-page":"343","DOI":"10.2214\/ajr.12.8862","article-title":"Diagnosis and management of cystic pancreatic lesions","volume":"200","author":"Sahani","year":"2013","journal-title":"AJR Am J Roentgenol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1159\/000537972","article-title":"Delayed presenting gastric duplication cyst mimicking a left adrenal cyst in a young female: a case report with a literature review","volume":"18","author":"Bapir","year":"2024","journal-title":"Case Rep Gastroenterol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e70528","DOI":"10.7759\/cureus.70528","article-title":"Pseudocysts of the adrenal gland: a systematic review of existing scientific literature from 2000\u20132023","volume":"16","author":"Dar","year":"2024","journal-title":"Cureus"},{"key":"B28","doi-asserted-by":"publisher","first-page":"288","DOI":"10.5114\/wiitm.2018.75872","article-title":"Adrenal cysts - optimal laparoscopic treatment","volume":"13","author":"Pogorzelski","year":"2018","journal-title":"Wideochir Inne Tech Maloinwazyjne"},{"key":"B29","doi-asserted-by":"publisher","first-page":"234592","DOI":"10.1155\/2015\/234592","article-title":"Laparoscopic management of a complex adrenal cyst","volume":"2015","author":"Kodama","year":"2015","journal-title":"Case Rep Urol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"3957","DOI":"10.1007\/s00464-013-3168-0","article-title":"SAGES guidelines for minimally invasive treatment of adrenal pathology","volume":"27","author":"Brunt","year":"2013","journal-title":"Surg Endosc"},{"key":"B31","doi-asserted-by":"publisher","first-page":"165","DOI":"10.4103\/0972-9941.19263","article-title":"Laparoscopic adrenalectomy","volume":"1","author":"Tsuru","year":"2005","journal-title":"J Minim Access Surg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1002\/iju5.12352","article-title":"Use of the SAND balloon catheter for safe and easy laparoscopic removal of adrenal cysts","volume":"4","author":"Ito","year":"2021","journal-title":"IJU Case Rep"},{"key":"B33","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1097\/00129689-200112000-00009","article-title":"Laparoscopic management of a giant adrenal cyst: case report","volume":"11","author":"Koksoy","year":"2001","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"B34","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1177\/000313489906500213","article-title":"Management of adrenal cysts","volume":"65","author":"Neri","year":"1999","journal-title":"Am Surg"},{"key":"B35","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1097\/01.ju.0000152177.35204.70","article-title":"Laparoscopic management of symptomatic and large adrenal cysts","volume":"173","author":"Castillo","year":"2005","journal-title":"J Urol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1111\/j.1464-410X.2009.08537.x","article-title":"Surgical management of adrenal cysts: single-institution experience","volume":"104","author":"El-Hefnawy","year":"2009","journal-title":"BJU Int"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1883619\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:48:02Z","timestamp":1788421682000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1883619\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":36,"alternative-id":["10.3389\/fsurg.2026.1883619"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1883619","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"1883619"}}