{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T12:41:23Z","timestamp":1774960883349,"version":"3.50.1"},"reference-count":84,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T00:00:00Z","timestamp":1718323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Leiomyosarcoma (LMS) originating from the adrenal gland is exceedingly rare, constituting a minute fraction of soft tissue sarcomas. Due to its rarity, with less than 50 documented cases in English medical literature, the diagnosis and management of adrenal LMS remain challenging. The aim of this study was to perform a review of the literature, in order to evaluate the prognosis of these rare cancers and report our specific case. Methods: A systematic review of the literature was conducted using PubMed, Web of Science, Google Scholar, and Scopus databases, up to December 2020. The search utilized MeSH terms such as \u201cAdrenal Gland Neoplasms,\u201d \u201cLeiomyosarcoma,\u201d \u201cAdrenalectomy,\u201d and \u201cSmooth Muscle Tumor.\u201d The inclusion criteria focused on studies reporting patients with a histopathological diagnosis of adrenal leiomyosarcoma. The PRISMA guidelines were followed to ensure a comprehensive analysis. Results: Out of 63 identified studies, 43 met the inclusion criteria and were reviewed. These studies highlighted the rarity and aggressive behavior of adrenal leiomyosarcoma. Surgical excision remains the cornerstone of treatment, often complemented by adjuvant therapies. The reviewed case involved a 52-year-old woman who underwent a right laparoscopic adrenalectomy for a 9 \u00d7 7 \u00d7 6 cm grade 3 leiomyosarcoma. Despite subsequent adjuvant chemotherapy, hepatic metastases were detected, illustrating the aggressive nature of the disease. The literature underscores the importance of histopathological analysis and long-term surveillance for managing disease progression. Conclusions: Optimal management of adrenal leiomyosarcoma requires a multidisciplinary approach and meticulous follow-up. The rarity of the disease poses challenges for standardizing treatment, but surgical excision and tailored adjuvant therapies show promise. Further research is essential to refine treatment strategies and improve prognosis for this rare malignancy.<\/jats:p>","DOI":"10.3390\/jcm13123499","type":"journal-article","created":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T06:29:43Z","timestamp":1718605783000},"page":"3499","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Outcomes and Follow-Up Trends in Adrenal Leiomyosarcoma: A Comprehensive Literature Review and Case Report"],"prefix":"10.3390","volume":"13","author":[{"given":"Federico Maria","family":"Mongardini","sequence":"first","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maddalena","family":"Paolicelli","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Catauro","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Conzo","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Flagiello","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giusiana","family":"Nesta","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosetta","family":"Esposito","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Ronchi","sequence":"additional","affiliation":[{"name":"Division of Pathology, Department of Mental Health and Preventive Medicine, Luigi Vanvitelli University of Campania, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Romano","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6969-4157","authenticated-orcid":false,"given":"Renato","family":"Patrone","sequence":"additional","affiliation":[{"name":"Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ludovico","family":"Docimo","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Conzo","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/j.radcr.2022.11.034","article-title":"Primary adrenal leiomyosarcoma","volume":"18","author":"Waack","year":"2022","journal-title":"Radiol. Case Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1186\/s12957-022-02584-4","article-title":"Leiomyosarcoma in the extremities and trunk wall: Systematic review and meta-analysis of the oncological outcomes","volume":"20","author":"Kannan","year":"2022","journal-title":"World J. Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.21873\/invivo.12034","article-title":"Review of the literature on leiomyoma and leiomyosarcoma of the adrenal gland: A systematic analysis of case reports","volume":"34","author":"Sakellariou","year":"2020","journal-title":"In Vivo"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"b2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.ciresp.2014.02.010","article-title":"Adrenal pleomorphic leiomyosarcoma, an uncommon malignant suprarenal tumour","volume":"93","year":"2015","journal-title":"Cir. Esp."},{"key":"ref_6","first-page":"1127","article-title":"Leiomiosarcoma de cava inferior. Hallazgo incidental [Leiomyosarcoma of the inferior vena cava. Incidental finding]","volume":"60","year":"2007","journal-title":"Arch. Esp. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.purol.2013.01.014","article-title":"L\u00e9iomyosarcome primitive de la surr\u00e9nale chez une noire africaine: Aspects diagnostiques et th\u00e9rapeutiques [Primary leiomyosarcoma of adrenal gland, in black African woman: Diagnosis and therapeutically aspects]","volume":"23","author":"Dekou","year":"2013","journal-title":"Prog Urol."},{"key":"ref_8","first-page":"459","article-title":"\ubd80\uc2e0\uc758 \uc6d0\ubc1c\uc131 \ud3c9\ud65c\uadfc\uc721\uc885\uc758 \uc601\uc0c1 \uc18c\uacac: \uc99d\ub840 \ubcf4\uace0 [Imaging Findings of Primary Adrenal Leiomyosarcoma: A Case Report]","volume":"81","author":"Yoon","year":"2020","journal-title":"Taehan Yongsang Uihakhoe Chi."},{"key":"ref_9","first-page":"435","article-title":"[Adrenalectomy for metastatic adrenal tumor from uterine leiomyosarcoma: A case report]","volume":"57","author":"Seki","year":"2011","journal-title":"Hinyokika Kiyo"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1002\/jso.2930160205","article-title":"Leiomyosarcoma of the adrenal gland and its angiographic features: A case report","volume":"16","author":"Choi","year":"1981","journal-title":"J. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1097\/00000478-199109000-00011","article-title":"Primary leiomyosarcoma of adrenal gland. Case report with immunohistochemical and ultrastructural study","volume":"15","author":"Lack","year":"1991","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_12","first-page":"1164","article-title":"Primary adrenal leiomyosarcoma in a man with acquired immunodeficiency syndrome (AIDS). Further evidence for an increase in smooth muscle tumors related to Epstein-Barr infection in AIDS","volume":"119","author":"Zetler","year":"1995","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_13","first-page":"834","article-title":"Latent Epstein-Barr virus infection demonstrated in low-grade leiomyosarcomas of adults with acquired immunodeficiency syndrome, but not in adjacent Kaposi\u2019s lesion or smooth muscle tumors in immunocompetent patients","volume":"121","author":"Boman","year":"1997","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1155\/S1357714X01000184","article-title":"Primary leiomyosarcoma of the adrenal gland","volume":"5","author":"Etten","year":"2001","journal-title":"Sarcoma."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1046\/j.1442-2042.2002.00413.x","article-title":"Adrenal leiomyosarcoma extending into the right atrium","volume":"9","author":"Matsui","year":"2002","journal-title":"Int. J. Urol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e32","DOI":"10.5858\/2003-127-e32-PLOTA","article-title":"Pleomorphic leiomyosarcoma of the adrenal gland","volume":"127","author":"Lujan","year":"2003","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_17","first-page":"47","article-title":"Adrenal leiomyosarcoma: A case report and literature review","volume":"35","author":"Thamboo","year":"2003","journal-title":"Pathology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1016\/j.surg.2003.07.007","article-title":"Laparoscopic excision of bilateral primary adrenal leiomyosarcoma in a 14-year old girl with acquired immunodeficiency syndrome (AIDS)","volume":"136","author":"Linos","year":"2004","journal-title":"Surgery"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s10147-004-0383-7","article-title":"Primary adrenal leiomyosarcoma with inferior vena cava thrombosis","volume":"9","author":"Kato","year":"2004","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1177\/014107680509800910","article-title":"Cold feet from adrenal leiomyosarcoma","volume":"98","author":"Wong","year":"2005","journal-title":"J. R. Soc. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1385\/EP:16:1:075","article-title":"Pleomorphic leiomyosarcoma of the adrenal gland with osteoclast-like giant cells","volume":"16","year":"2005","journal-title":"Endocr. Pathol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s00261-005-0343-3","article-title":"Primary adrenal leiomyosarcoma","volume":"31","author":"Lee","year":"2006","journal-title":"Abdom. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"591.e5","DOI":"10.1016\/j.urology.2007.07.029","article-title":"Pleomorphic leiomyosarcoma of the adrenal gland: Case report and review of the literature","volume":"70","author":"Mohanty","year":"2007","journal-title":"Urology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/1477-7819-5-109","article-title":"Leiomyosarcoma of the adrenal vein: A novel approach to surgical resection","volume":"5","author":"Wang","year":"2007","journal-title":"World J. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1507\/endocrj.K07E-020","article-title":"A rare tumor in the adrenal region: Neuron-specific enolase (NSE)-producing leiomyosarcoma in an elderly hypertensive patient","volume":"55","author":"Goto","year":"2008","journal-title":"Endocr. J."},{"key":"ref_26","first-page":"353","article-title":"Primary adrenal leiomyosarcoma: A case report and literature review","volume":"2","author":"Mencoboni","year":"2008","journal-title":"Clin. Med. Oncol."},{"key":"ref_27","first-page":"469","article-title":"The diagnostic hurdle of an elderly male with bone pain: How 18F-FDG-PET led to diagnosis of a leiomyosarcoma of the adrenal gland","volume":"29","author":"Vinken","year":"2009","journal-title":"Anticancer. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1007\/s10147-008-0844-5","article-title":"Bilateral adrenal leiomyosarcoma treated with multiple local therapies","volume":"14","author":"Hamada","year":"2009","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.7863\/jum.2010.29.9.1369","article-title":"Sonographic findings of an adrenal leiomyosarcoma","volume":"29","author":"Karaosmanoglu","year":"2010","journal-title":"J. Ultrasound Med."},{"key":"ref_30","first-page":"428","article-title":"Leiomyosarcoma of the adrenal vein","volume":"35","author":"Shao","year":"2012","journal-title":"Chang. Gung Med. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/1477-7819-10-64","article-title":"Three uncommon adrenal incidentalomas: A 13-year surgical pathology review","volume":"10","author":"Kanthan","year":"2012","journal-title":"World J. Surg. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"144","DOI":"10.4103\/0973-1482.110394","article-title":"Primary adrenal leiomyosarcoma: A case report with immunohistochemical study and review of literature","volume":"9","author":"Deshmukh","year":"2013","journal-title":"J. Cancer Res. Ther."},{"key":"ref_33","first-page":"489630","article-title":"Primary leiomyosarcoma of the adrenal gland: A case report with immunohistochemical study and literature review","volume":"2014","author":"Gulpinar","year":"2014","journal-title":"Case Rep. Urol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"5275","DOI":"10.4081\/rt.2014.5275","article-title":"Vena Cava invasion by Adrenal Leiomyosarcoma","volume":"6","author":"Ozturk","year":"2014","journal-title":"Rare Tumors"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"423","DOI":"10.4132\/KoreanJPathol.2014.48.6.423","article-title":"Primary leiomyosarcoma of adrenal gland with tissue eosinophilic infiltration","volume":"48","author":"Lee","year":"2014","journal-title":"Korean J. Pathol."},{"key":"ref_36","first-page":"403","article-title":"Primary adrenal leiomyosarcoma: A case report and review of the literature","volume":"78","author":"Bhalla","year":"2014","journal-title":"Conn. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1177\/1066896914526777","article-title":"Primary adrenal leiomyosarcoma: Case report and review of the literature","volume":"22","author":"Wei","year":"2014","journal-title":"Int. J. Surg. Pathol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.4158\/EP14197.CR","article-title":"Recurrent primary adrenal leiomyosarcoma: A complete literature review and presentation of a rare adrenal tumor","volume":"1","author":"Manzano","year":"2015","journal-title":"AACE Clin. Case Rep."},{"key":"ref_39","first-page":"702541","article-title":"Primary adrenal leiomyosarcoma in an arab male: A rare case report with immunohistochemistry study","volume":"2015","author":"Nagaraj","year":"2015","journal-title":"Case Rep. Surg."},{"key":"ref_40","first-page":"4258","article-title":"Primary adrenal leiomyosarcoma: A case report and review of literature","volume":"8","author":"Zhou","year":"2015","journal-title":"Int. J. Clin. Exp. Pathol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.endonu.2015.05.008","article-title":"Primary adrenal leiomyosarcoma treated by laparoscopic adrenalectomy","volume":"62","author":"Quildrian","year":"2015","journal-title":"Endocrinol. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1186\/s12957-016-0936-z","article-title":"Primary adrenal leiomyosarcoma with lymph node metastasis: A case report","volume":"14","author":"Onishi","year":"2016","journal-title":"World J. Surg. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"s58","DOI":"10.1016\/j.urols.2016.05.212","article-title":"Rare care report: Primary leiomyosarcoma of the adrenal gland and literature review","volume":"27","author":"Li","year":"2016","journal-title":"Urol. Sci."},{"key":"ref_44","first-page":"1193","article-title":"Primary adrenal dedifferentiated leiomyosarcoma: A low grade leiomyosarcoma with a high-grade undifferentiated component: Case report","volume":"1","author":"Rudin","year":"2016","journal-title":"Clin. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"935","DOI":"10.4172\/2165-7920.1000935","article-title":"Primary adrenal leiomyosarcoma in an aged japanese woman: A rare case report","volume":"7","author":"Aoki","year":"2017","journal-title":"J. Clin. Case Rep."},{"key":"ref_46","first-page":"1014","article-title":"Adrenal gland: An anatomical site of surprises: On occasion of a primary leiomyosarcoma","volume":"2","author":"Tzaida","year":"2017","journal-title":"Ann. Clin. Exp. Metabol."},{"key":"ref_47","first-page":"8196051","article-title":"First reported case of endoscopic ultrasound-guided core biopsy yielding diagnosis of primary adrenal leiomyosarcoma","volume":"2018","author":"Mulani","year":"2018","journal-title":"Case Rep. Gastrointest. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e227670","DOI":"10.1136\/bcr-2018-227670","article-title":"Primary adrenal leiomyosarcoma with inferior vena cava extension in a 70-year-old man","volume":"12","author":"Doppalapudi","year":"2019","journal-title":"BMJ Case Rep."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/s13691-019-00387-1","article-title":"Adrenal leiomyosarcoma in a young adult male","volume":"9","author":"Nerli","year":"2019","journal-title":"Int. Cancer Conf. J."},{"key":"ref_50","first-page":"317","article-title":"Primary adrenal leiomyosarcoma: A case report","volume":"12","author":"Sakellariou","year":"2020","journal-title":"Mol. Clin. Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"559","DOI":"10.4103\/ijmpo.ijmpo_270_19","article-title":"Primary adrenal leiomyosarcoma: An extremely rare mesenchymal tumor","volume":"40","author":"Lokanatha","year":"2019","journal-title":"Indian J. Med. Paediatr. Oncol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1007\/s00464-001-8302-8","article-title":"The positive impact of laparoscopic adrenalectomy on complications of adrenal surgery","volume":"16","author":"Brunt","year":"2002","journal-title":"Surg. Endosc."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"26","DOI":"10.4103\/aam.aam_10_19","article-title":"Open adrenalectomy: A 20-year review of our experience in a developing country","volume":"19","author":"Usta","year":"2020","journal-title":"Ann. Afr. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1590\/S0004-27302008000900017","article-title":"Leiomiossarcoma prim\u00e1rio de adrenal [Primary adrenal leiomyosarcoma]","volume":"52","author":"Tomasich","year":"2008","journal-title":"Arq. Bras. Endocrinol. Metabol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.cvsm.2021.12.005","article-title":"Update on Adrenalectomy","volume":"52","author":"Hayes","year":"2022","journal-title":"Vet. Clin. North. Am. Small Anim. Pract."},{"key":"ref_56","first-page":"189","article-title":"Mi\u0119\u015bniakomi\u0119sak g\u0142adkokom\u00f3rkowy nadnercza\u2014opis dw\u00f3ch przypadk\u00f3w [Leiomyosarcoma of the adrenal gland\u2014two cases report]","volume":"45","author":"Samsel","year":"2018","journal-title":"Pol. Merkur. Lekarski."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.3389\/fonc.2020.01653","article-title":"Multiple Chromoanasynthesis in a Rare Case of Sporadic Renal Leiomyosarcoma: A Case Report","volume":"10","author":"Anoshkin","year":"2020","journal-title":"Front. Oncol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1038\/nrg816","article-title":"The fundamental role of epigenetic events in cancer","volume":"3","author":"Jones","year":"2002","journal-title":"Nat. Rev. Genet."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1146\/annurev.pathol.4.110807.092222","article-title":"MicroRNAs in cancer","volume":"4","author":"Lee","year":"2009","journal-title":"Annu. Rev. Pathol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.ctrv.2008.01.007","article-title":"Mechanisms and strategies to overcome chemotherapy resistance in metastatic breast cancer","volume":"34","author":"Coley","year":"2008","journal-title":"Cancer Treat. Rev."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.eururo.2014.09.049","article-title":"Understanding the mechanisms of androgen deprivation resistance in prostate cancer at the molecular level","volume":"67","author":"Karantanos","year":"2015","journal-title":"Eur. Urol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1016\/S0140-6736(12)60651-5","article-title":"EORTC Soft Tissue and Bone Sarcoma Group; PALETTE study group. Pazopanib for metastatic soft-tissue sarcoma (PALETTE): A randomized, double-blind, placebo-controlled phase 3 trial","volume":"379","author":"Blay","year":"2012","journal-title":"Lancet"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1200\/JCO.2015.62.4734","article-title":"Efficacy and Safety of Trabectedin or Dacarbazine for Metastatic Liposarcoma or Leiomyosarcoma After Failure of Conventional Chemotherapy: Results of a Phase III Randomized Multicenter Clinical Trial","volume":"34","author":"Demetri","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1016\/S1470-2045(22)00380-1","article-title":"Doxorubicin alone versus doxorubicin with trabectedin followed by trabectedin alone as first-line therapy for metastatic or unresectable leiomyosarcoma (LMS-04): A andomized, multicentre, open-label phase 3 trial","volume":"23","author":"Pautier","year":"2022","journal-title":"Lancet Oncol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"119504","DOI":"10.1016\/j.lfs.2021.119504","article-title":"Epigenetic modulation and understanding of HDAC inhibitors in cancer therapy","volume":"277","author":"Ramaiah","year":"2021","journal-title":"Life Sci."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"a026831","DOI":"10.1101\/cshperspect.a026831","article-title":"HDACs and HDAC Inhibitors in Cancer Development and Therapy","volume":"6","author":"Li","year":"2016","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"775761","DOI":"10.3389\/fimmu.2021.775761","article-title":"Improving Immunotherapy Efficacy in Soft-Tissue Sarcomas: A Biomarker Driven and Histotype Tailored Review","volume":"12","author":"Nassif","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e170324","DOI":"10.1172\/jci.insight.170324","article-title":"Immunosurveillance shapes the emergence of neo-epitope landscapes of sarcomas, revealing prime targets for immunotherapy","volume":"8","author":"Sedlacek","year":"2023","journal-title":"JCI Insight"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s13304-017-0440-1","article-title":"Open adrenalectomy in the era of laparoscopic surgery: A review","volume":"69","author":"Taffurelli","year":"2017","journal-title":"Updates Surg."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1002\/bjs.4738","article-title":"Laparoscopic adrenalectomy","volume":"91","author":"Assalia","year":"2004","journal-title":"Br. J. Surg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.jviscsurg.2017.06.010","article-title":"Surgical treatment of adrenal carcinoma","volume":"154","author":"Gaujoux","year":"2017","journal-title":"J. Visc. Surg."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"106779","DOI":"10.1016\/j.ijsu.2022.106779","article-title":"Safety and effectiveness of minimally invasive adrenalectomy versus open adrenalectomy in patients with large adrenal tumors (\u22655 cm): A meta-analysis and systematic review","volume":"104","author":"Gan","year":"2022","journal-title":"Int. J. Surg."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1001\/jamasurg.2022.3544","article-title":"American Association of Endocrine Surgeons Guidelines for Adrenalectomy: Executive Summary","volume":"157","author":"Yip","year":"2022","journal-title":"JAMA Surg."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"102392","DOI":"10.18632\/oncotarget.22059","article-title":"Innovation in endocrine surgery: Robotic versus laparoscopic adrenalectomy. Meta-analysis and systematic literature review","volume":"8","author":"Agrusa","year":"2017","journal-title":"Oncotarget"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Danwang, C., Agbor, V.N., and Bigna, J.J. (2020). Obesity and postoperative outcomes of the patients with laparoscopic adrenalectomy: A systematic review and meta-analysis. BMC Surg., 20.","DOI":"10.1186\/s12893-020-00848-y"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1210\/er.2013-1029","article-title":"Adrenocortical carcinoma","volume":"35","author":"Else","year":"2014","journal-title":"Endocr. Rev."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2746","DOI":"10.1007\/s00268-017-4095-3","article-title":"Evaluation of Open and Minimally Invasive Adrenalectomy: A Systematic Review and Network Meta-analysis","volume":"41","author":"Heger","year":"2017","journal-title":"World J. Surg."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.ijsu.2018.04.013","article-title":"Robotic resection of benign nonadrenal retroperitoneal tumors: A consecutive case series","volume":"55","author":"Liu","year":"2018","journal-title":"Int. J. Surg."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Patrone, R., Gambardella, C., Romano, R.M., Gugliemo, C., Offi, C., Andretta, C., Vitiello, A., Tartaglia, E., Flagiello, L., and Conzo, A. (2019). The impact of the ultrasonic, bipolar and integrated energy devices in the adrenal gland surgery: Literature review and our experience. BMC Surg., 18.","DOI":"10.1186\/s12893-018-0457-5"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Conzo, G., Patrone, R., Flagiello, L., Catauro, A., Conzo, A., Cacciatore, C., Mongardini, F.M., Cozzolino, G., Esposito, R., and Pasquali, D. (2023). Impact of Current Technology in Laparoscopic Adrenalectomy: 20 Years of Experience in the Treatment of 254 Consecutive Clinical Cases. J. Clin. Med., 12.","DOI":"10.3390\/jcm12134384"},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Coppola Bottazzi, E., Gambardella, C., Mongardini, F.M., Vanella, S., Noviello, A., Palma, T., Murano, R., De Chiara, G., Conzo, G., and Docimo, L. (2023). Prognosis of Adrenal Oncocytic Neoplasms (AONs): Literature Review of 287 Cases and Presentation of the Oldest Patient. J. Clin. Med., 12.","DOI":"10.3390\/jcm12216925"},{"key":"ref_82","first-page":"161","article-title":"Complications following adrenal surgery","volume":"83","author":"McLeod","year":"1991","journal-title":"J. Natl. Med. Assoc."},{"key":"ref_83","first-page":"506182","article-title":"Guidelines for the management of soft tissue sarcomas","volume":"2010","author":"Grimer","year":"2010","journal-title":"Sarcoma"},{"key":"ref_84","first-page":"253","article-title":"Adrenal leiomyosarcoma: Clues for a correct diagnosis","volume":"29","author":"Duregon","year":"2018","journal-title":"Endocr. Pathol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/12\/3499\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:59:08Z","timestamp":1760108348000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/12\/3499"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,14]]},"references-count":84,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["jcm13123499"],"URL":"https:\/\/doi.org\/10.3390\/jcm13123499","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,14]]}}}