Limits...
Ectopic adrenocortical adenoma in the renal hilum: a case report and literature review.

Liu Y, Jiang YF, Wang YL, Cao HY, Wang L, Xu HT, Li QC, Qiu XS, Wang EH - Diagn Pathol (2016)

Bottom Line: This case provides a reminder to pathologists to be aware of atypical cases of this benign tumor.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China. lyonliuyang@mail.cmu.edu.cn.

ABSTRACT

Background: 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.

Case presentation: 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.

Conclusions: 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.

No MeSH data available.


Related in: MedlinePlus

Imaging examination results of the patient. a Computed tomography (CT) urography and three dimensional reconstruction show the ureters bilaterally, without any obvious expansion. Enhanced CT and coronal reconstruction showing b a soft-tissue mass with a maximum diameter of 2.7 cm in the left renal hilum, near the renal pelvis and c an atrophic bilateral adrenals in sagittal view
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4837621&req=5

Fig1: Imaging examination results of the patient. a Computed tomography (CT) urography and three dimensional reconstruction show the ureters bilaterally, without any obvious expansion. Enhanced CT and coronal reconstruction showing b a soft-tissue mass with a maximum diameter of 2.7 cm in the left renal hilum, near the renal pelvis and c an atrophic bilateral adrenals in sagittal view

Mentions: A 27-year-old Chinese female complained of amenorrhea of 3 months duration. Her medical history and that of her family was unremarkable. Her body mass index (BMI) and blood pressure (BP) were within the normal range (BMI: 19, height 165 cm, body weight: 62 kg, BP: 120/85 mmHg). Virilization and other clinical hormonal abnormalities were not noted, except for a borderline elevation of testosterone. Multislice spiral computed tomography (CT) urography revealed a well-circumscribed, round, soft-tissue mass with a maximum diameter of 2.7 cm in the left renal hilum, near the renal pelvis and atrophic bilateral adrenals. The CT value for the unenhanced mass was 35 HU; following contrast agent administration, it increased to 161 HU. Multislice spiral CT urography showed no abnormalities in kidney blood flow or renal perfusion. Renal function was normal, except for a slight delay in renal excretion (Fig. 1). The tumor was clinically diagnosed as an angiomyolipoma and was excised in urinary surgery. During the operation, the mass in the left renal hilum was fully resected, sparing the kidney and was sent for pathology examination. Rapid intraoperative pathological diagnosis suggested oncocytoma, but paraganglioma and renal cell carcinoma could not be excluded. Based on the postoperative pathology results, the diagnosis was ectopic adrenocortical adenoma. The patient is alive with no tumor recurrence or metastasis after 3 months of follow-up.Fig. 1


Ectopic adrenocortical adenoma in the renal hilum: a case report and literature review.

Liu Y, Jiang YF, Wang YL, Cao HY, Wang L, Xu HT, Li QC, Qiu XS, Wang EH - Diagn Pathol (2016)

Imaging examination results of the patient. a Computed tomography (CT) urography and three dimensional reconstruction show the ureters bilaterally, without any obvious expansion. Enhanced CT and coronal reconstruction showing b a soft-tissue mass with a maximum diameter of 2.7 cm in the left renal hilum, near the renal pelvis and c an atrophic bilateral adrenals in sagittal view
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4837621&req=5

Fig1: Imaging examination results of the patient. a Computed tomography (CT) urography and three dimensional reconstruction show the ureters bilaterally, without any obvious expansion. Enhanced CT and coronal reconstruction showing b a soft-tissue mass with a maximum diameter of 2.7 cm in the left renal hilum, near the renal pelvis and c an atrophic bilateral adrenals in sagittal view
Mentions: A 27-year-old Chinese female complained of amenorrhea of 3 months duration. Her medical history and that of her family was unremarkable. Her body mass index (BMI) and blood pressure (BP) were within the normal range (BMI: 19, height 165 cm, body weight: 62 kg, BP: 120/85 mmHg). Virilization and other clinical hormonal abnormalities were not noted, except for a borderline elevation of testosterone. Multislice spiral computed tomography (CT) urography revealed a well-circumscribed, round, soft-tissue mass with a maximum diameter of 2.7 cm in the left renal hilum, near the renal pelvis and atrophic bilateral adrenals. The CT value for the unenhanced mass was 35 HU; following contrast agent administration, it increased to 161 HU. Multislice spiral CT urography showed no abnormalities in kidney blood flow or renal perfusion. Renal function was normal, except for a slight delay in renal excretion (Fig. 1). The tumor was clinically diagnosed as an angiomyolipoma and was excised in urinary surgery. During the operation, the mass in the left renal hilum was fully resected, sparing the kidney and was sent for pathology examination. Rapid intraoperative pathological diagnosis suggested oncocytoma, but paraganglioma and renal cell carcinoma could not be excluded. Based on the postoperative pathology results, the diagnosis was ectopic adrenocortical adenoma. The patient is alive with no tumor recurrence or metastasis after 3 months of follow-up.Fig. 1

Bottom Line: This case provides a reminder to pathologists to be aware of atypical cases of this benign tumor.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China. lyonliuyang@mail.cmu.edu.cn.

ABSTRACT

Background: 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.

Case presentation: 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.

Conclusions: 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.

No MeSH data available.


Related in: MedlinePlus