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Adrenocortical Adenoma
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Hironobu Sasano – One of the best experts on this subject based on the ideXlab platform.
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a case of Adrenocortical Adenoma harboring venous thrombus mimicking adrenal malignancy
Endocrine Journal, 2021Co-Authors: Agena Suzuki, Yuto Yamazaki, Hironobu Sasano, Yuji Kamata, Tomomi Taguchi, Koji Takano, Masayoshi ShichiriAbstract:Advances in imaging technology and its widespread use have increased the number of identified patients with bilateral adrenal incidentalomas. The pathology of bilateral adrenal incidentalomas is gradually elucidated by its increased frequency. Although there is no consensus regarding the optimal management of bilateral adrenal lesions, adrenal lesions that are a suspected Adrenocortical carcinoma on the basis of radiological imaging require surgical resection. We report a clinically interesting case of a 59-year-old female with Adrenocortical Adenoma harboring venous thrombus that mimicked adrenal malignancy. She was referred for evaluation of asymptomatic asymmetric lesions on both adrenal glands. Abdominal computed tomography and magnetic resoresonanceging showed a 4.7-cm-diameter heterogenous lesion with peripheral enhancement in the right adrenal gland and a 2.0-cm-diameter homogenous lesion in the left adrenal gland. Adrenal scintigraphy with 131I-adosterol exhibited marked accumulation in the left lesion and slight accumulation in the middle inferior portion of the right lesion. Endocrine data revealed subclinical Cushing syndrome, and the patient underwent right laparoscopic adrenalectomy. The serum cortisol level was not suppressed on an overnight dexamethasone suppression test after the adrenalectomy. The resected tumor revealed a cortisol-producing Adrenocortical Adenoma harboring an organized and re-canalized venous thrombus, which was associated with focal papillary endothelial hyperplasia. This case illustrates the difficulty with preoperatively diagnosing this heterogeneously enhanced large benign adrenal lesion and differentiating it from Adrenocortical carcinoma or angiosarcoma.
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non functional Adrenocortical Adenoma a unique case of combination with myelolipoma and endothelial cysts
Pathology Research and Practice, 2011Co-Authors: Sohsuke Yamada, Hironobu Sasano, Akihide Tanimoto, Keyong Wang, Yan Ding, Xin Guo, Shohei Shimajiri, Yasuyuki SasaguriAbstract:A case of non-functioning Adrenocortical Adenoma combined with myelolipoma and endothelial cysts is reported. A 72-year-old Japanese female was noticed to have right renal and left adrenal tumors by an abdominal CT scan. At surgery, the mildly enlarged left adrenal gland contained a well-demarcated tumor. Macroscopically, it was yellowish to dark red or grayish in color, and was characterized by geographic appearance on the cut surface. Histopathological examination revealed a solid proliferation of clear or compact cells and a normal rim of adrenal gland, coexisting with vascular multiple cysts and myelolipomas. The cysts were filled with clotted blood, fibrinous material, or thrombi, and were partially lined with flattened endothelial cells with focal papillary hyperplasia, which were immunohistochemically positive for CD31 and CD34. These cystic walls were often thickened with hyalinized fibrosis and calcification, and were connected to myelolipomatous elements. To our knowledge, this is the first case report of Adrenocortical Adenoma associated with myelolipoma and endothelial cysts. It is probable that the extensive degeneration in Adenoma might induce myelolipomatous metaplasia and cystic vascular formation.
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coexistence of aldosterone producing Adrenocortical Adenoma and pheochromocytoma in an ipsilateral adrenal gland
Endocrine Journal, 2009Co-Authors: Noriko Sakamoto, Katsuyoshi Tojo, Takatoshi Saito, Kei Fujimoto, Tsuyoshi Isaka, Naoko Tajima, Keiichi Ikeda, Hironori Yamada, Nozomu Furuta, Hironobu SasanoAbstract:A 40-year-old female, diagnosed as essential hypertension, demonstrated a 2 cm mass in left adrenal gland by computed tomography without abnormal endocrinological findings. 131 I-adosterol and 123 I-metaiodobenzylguanidine (MIBG) scintigraphy at 39 years of age showed no abnormal accumulation. Follow up 131 I-adosterol scintigraphy performed one year later showed apparently abnormal uptake and slightly elevated uptake in left adrenal gland. Her physical examination was unremarkable except for mild hypertension. Routine blood chemistry was normal except for hypokalemia. Endocrinological date revealed suppressed plasma renin activity, and elevated plasma aldosterone concentration, and noradrenalin levels. Serial T2-weighted magnetic resoresonanceging clearly demonstrated two distinct tumors. Furthermore, selective adrenal venous sampling with intravenous ACTH infusion indicated aldosterone-producing Adrenocortical Adenoma (APA) in left adrenal gland. During operation of adrenal tumor, blood pressure elevated markedly and complication of pheochromocytoma (PC) was suspected. Immunohistochemical findings after left adrenolectomy revealed that the adrenal mass was compatible with APA and PC. Risk of operation against undiagnosed PC is very high and, therefore, it must be diagnosed before surgery. Herein, we present an extremely rare case of the simultaneous occurrence of both APA and PC in an ipsilateral adrenal gland.
Simone S Aguiar – One of the best experts on this subject based on the ideXlab platform.
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a unique case of synchronous functional Adrenocortical Adenoma and myelolipoma within the ectopic adrenal cortex in a child with beckwith wiedemann syndrome
Pathology Research and Practice, 2012Co-Authors: Izilda A Cardinalli, Antonio Goncalves De Oliveirafilho, Maria Jose Mastellaro, Raul C Ribeiro, Simone S AguiarAbstract:We report a unique case of synchronous functional Adrenocortical Adenoma and an incidental myelolipoma within ectopic cortical adrenal tissue located in the renal hilum in a child with Beckwith-Wiedemann syndrome and review the association between adrenal gland disorders and myelolipomas. To the best of our knowledge, this is the first documented case of a simultaneous occurrence of these three conditions. A 17-month-old child with Beckwith-Wiedemann syndrome was diagnosed with a left adrenal tumor during complementary radiologic studies. Biochemical investigation before surgery showed elevated blood levels of cortisol and dehydroepiandrosterone hormones. The patient underwent a left adrenalectomy with ipsilateral renal hilar and intercaval-aortic lymph node dissection. Pathology findings revealed a left Adrenocortical Adenoma and an incidental myelolipoma growing within ectopic cortical adrenal tissue in the renal hilum. The patient is doing well and does not have any current health issues. Patients with adrenal cortex disorders, such as hyperplasias and neoplasms, particularly when associated with hormonal imbalances, may have an increased risk of developing myelolipomas. Whether Beckwith-Wiedemann syndrome may, by itself, contribute to simultaneous occurrence of Adrenocortical Adenomas and myelolipomas remains to be clarified.
Jingping Yuan – One of the best experts on this subject based on the ideXlab platform.
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Myxoid Adrenocortical Adenoma with a pseudoglandular pattern: a case report and literature review.
International journal of clinical and experimental pathology, 2017Co-Authors: Zhi Zeng, Zi-ying Zhou, Lin Liu, Honglin Yan, Ya-bing Huang, Ze-sheng Wang, Jun Chen, Jingping YuanAbstract:Adrenocortical Adenoma is a benign neopneoplasm derived from cells of the adrenal cortex. The myxoid variant of this tumor is extremely rare. To our knowledge, only 23 cases of myxoid Adrenocortical Adenoma have been reported so far and 19 of them mentioned the pseudoglandular pattern. We reported a new case of 56-year-old Chinese female patient whose left adrenal gland was shown a neoplastic lesion by computed tomography (CT) and magnetic resonance (MR) imaging. Histopathological study showed that the mass was a myxoid Adrenocortical Adenoma with a pseudoglandular pattern. Then, we performed immunohistochemistry with 28 biomarkers to make differential diagnosis and found that tumor cells were diffusely positive for vimentin, melan-A, CD56, NSE and USP10, and focally positive for cytokeratin pan, cytokeratin 8/18 and VEGF. The labeling index of Ki-67 and Cyclin D1 were about 1% and 50%, respectively. No immunoreactivity was found for EMA, cytokeratin 7, HMB45, S-100, alpha-inhibin, calretinin, synaptophysin, chromogranin A, P53, EGFR, MMP2, DNA topo II alpha, CA125, E-cadherin, P63, P16 and Her-2. The patient has been followed up for 37 months after tumor resection and no evidence was found to suggest any local recurrence or any metastatic disease. Myxoid Adrenocortical Adenoma with a pseudoglandular pattern is extremely rare. The accurate diagnosis should be based on combined consideration of clinical characteristics, CT, MR imaging and pathological features, and should be distinguished from other retroperitoneal myxoid tumors.
Izilda A Cardinalli – One of the best experts on this subject based on the ideXlab platform.
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a unique case of synchronous functional Adrenocortical Adenoma and myelolipoma within the ectopic adrenal cortex in a child with beckwith wiedemann syndrome
Pathology Research and Practice, 2012Co-Authors: Izilda A Cardinalli, Antonio Goncalves De Oliveirafilho, Maria Jose Mastellaro, Raul C Ribeiro, Simone S AguiarAbstract:We report a unique case of synchronous functional Adrenocortical Adenoma and an incidental myelolipoma within ectopic cortical adrenal tissue located in the renal hilum in a child with Beckwith-Wiedemann syndrome and review the association between adrenal gland disorders and myelolipomas. To the best of our knowledge, this is the first documented case of a simultaneous occurrence of these three conditions. A 17-month-old child with Beckwith-Wiedemann syndrome was diagnosed with a left adrenal tumor during complementary radiologic studies. Biochemical investigation before surgery showed elevated blood levels of cortisol and dehydroepiandrosterone hormones. The patient underwent a left adrenalectomy with ipsilateral renal hilar and intercaval-aortic lymph node dissection. Pathology findings revealed a left Adrenocortical Adenoma and an incidental myelolipoma growing within ectopic cortical adrenal tissue in the renal hilum. The patient is doing well and does not have any current health issues. Patients with adrenal cortex disorders, such as hyperplasias and neoplasms, particularly when associated with hormonal imbalances, may have an increased risk of developing myelolipomas. Whether Beckwith-Wiedemann syndrome may, by itself, contribute to simultaneous occurrence of Adrenocortical Adenomas and myelolipomas remains to be clarified.
Enhua Wang – One of the best experts on this subject based on the ideXlab platform.
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Ectopic Adrenocortical Adenoma in the renal hilum: a case report and literature review
Diagnostic pathology, 2016Co-Authors: Yang Liu, Yue-feng Jiang, Ye-lin Wang, Hong-yi Cao, Liang Wang, Xueshan Qiu, Enhua WangAbstract:Ectopic (accessory) Adrenocortical tissue, also known as adrenal rests, is a developmental abnormality of the adrenal gland. The most common ectopic site is in close proximity to the adrenal glands and along the path of descent or migration of the gonads because of the close spatial relationship between the Adrenocortical primordium and gonadal blastema during embryogenesis. Ectopic rests may undergo marked hyperplasia, and occasionally induce ectopic Adrenocortical Adenomas or carcinomas. A 27-year-old Chinese female patient who presented with amenorrhea of 3 months duration underwent computed tomography urography after ultrasound revealed a solitary mass in the left renal hilum. Histologically, the prominent eosinophilic tumor cells formed an alveolar- or acinar-like configuration. The immunohistochemical profile (alpha-inhibin+, Melan-A+, synaptophysin+) indicated the Adrenocortical origin of the tumor, diagnosed as ectopic Adrenocortical Adenoma. The patient was alive with no tumor recurrence or metastasis at the 3-month follow-up examination. The unusual histological appearance of ectopic Adrenocortical Adenoma may result in its misdiagnosis as oncocytoma or clear cell renal cell carcinoma, especially if the specimen is limited. This case provides a reminder to pathologists to be aware of atypical cases of this benign tumor. Although uncommon, an ectopic adrenal lesion should be included in the differential diagnosis of tumors involving the renal hilum. A misdiagnosis of this benign condition as a malignant renal tumor may have severe consequences for the patient, including unnecessary radical nephrectomy. Preoperative biopsy and appropriate immunohistochemical staining will assist in determining the origin and nature of the tumor and in avoiding intraoperative uncertainty.