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San Juan MD, Lagamayo D, Carnate J, Joven MH. Oncocytic adrenocortical neoplasm with undetermined malignant potential and autonomous cortisol secretion. BMJ Case Rep 2022; 15:e248525. [PMID: 35444021 PMCID: PMC9021750 DOI: 10.1136/bcr-2021-248525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/04/2022] Open
Abstract
Increasing incidence of adrenal incidentalomas with hypercortisolemia not associated with overt features of Cushing's syndrome has led to the evolution of the term autonomous cortisol secretion. Oncocytic adrenocortical neoplasms (OANs) are rare adrenal cortex neoplasms with only 250 reported cases worldwide. We present a woman in her 30s with menometrorrhagia, weight gain and increasing abdominal girth who was found to have a large right adrenal mass on abdominal CT scan. Serum cortisol was not suppressed after 1 mg dexamethasone (31.5 µg/dL) and adrenocorticotrophic hormone was not detectable (<1.0 pg/mL). She underwent right adrenalectomy under glucocorticoid coverage. Hypertension, weight, visceral adiposity and menometrorrhagia improved postoperatively. Histopathology with immunohistochemistry showed OAN with undetermined malignant potential. These kinds of tumours can only be definitively diagnosed postsurgically using the Lin-Weiss-Bisceglia system. Although they have better prognosis compared with adrenocortical carcinomas and do not require chemotherapy, patients should be closely monitored to identify recurrence promptly.
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Affiliation(s)
- Mari Des San Juan
- Section of Endocrinology, Diabetes, and Metabolism, The Medical City, Pasig City, Philippines
| | - Dian Lagamayo
- Department of Laboratory Medicine and Pathology, The Medical City, Pasig City, Philippines
| | - Jose Carnate
- Department of Laboratory Medicine and Pathology, The Medical City, Pasig City, Philippines
| | - Mark Henry Joven
- Section of Endocrinology, Diabetes, and Metabolism, The Medical City, Pasig City, Philippines
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
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2
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Panizzo V, Rubino B, Piozzi GN, Ubiali P, Morandi A, Nencioni M, Micheletto G. Laparoscopic Trans-Abdominal Right Adrenalectomy for a Large Primitive Adrenal Oncocytic Carcinoma: A Case Report and Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1096-1102. [PMID: 30217968 PMCID: PMC6152586 DOI: 10.12659/ajcr.910259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Patient: Male, 48 Final Diagnosis: Adrenal oncocytic carcinoma Symptoms: Asymptomatic Medication: — Clinical Procedure: Transabdominal laparoscopic right adrenalectomy Specialty: Surgery
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Affiliation(s)
- Valerio Panizzo
- Department of General Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Barbara Rubino
- Department of Pathology and Cytodiagnostic, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Paolo Ubiali
- Department of General Surgery, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda - Maggiore Policlinico Hospital, Milan, Italy
| | - Marco Nencioni
- Department of General Surgery, San Raffaele Hospital, Milan, Italy
| | - Giancarlo Micheletto
- Department of General Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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3
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Kanitra JJ, Hardaway JC, Soleimani T, Koehler TJ, McLeod MK, Kavuturu S. Adrenocortical oncocytic neoplasm: A systematic review. Surgery 2018; 164:1351-1359. [PMID: 30037428 DOI: 10.1016/j.surg.2018.04.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/04/2018] [Accepted: 04/13/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Adrenocortical oncocytic neoplasms are rare tumors, generally regarded as benign and hormonally nonfunctional. We performed a systematic review to update the literature on adrenocortical oncocytic neoplasms by reviewing patient and tumor characteristics, as well as management trends, because the literature is composed of predominately single-case reports. METHODS A systematic search was performed in PubMed, Embase, and Cochrane Library through June 2017. Malignant potential was determined by applying the Lin-Weiss-Bisceglia criteria to cases. RESULTS Included for analysis were 84 citations describing 140 adrenocortical oncocytic neoplasms, including our own case. These were diagnosed predominantly in females (66%), on the left side (64%), and were nonfunctional (66%). Average age at diagnosis was 44 years (2.5-77), and median tumor size was 80 mm (16-285). A total of 35% of adrenocortical oncocytic neoplasms were benign, 41% borderline, and 24% malignant. Male patients were more likely to have a malignant tumor compared with females (36% versus 18%, P = .035). The 5-year overall survival for benign adrenocortical oncocytic neoplasms was 100%, borderline 88%, and malignant 47%. Hormonal function did not discriminate malignant from benign lesions. Adrenocortical oncocytic neoplasms that stained positive for synaptophysin (50%, P < .001) and negative for vimentin (62%, P = .009) are more often benign. CONCLUSION We found that the majority of adrenocortical oncocytic neoplasms (65%) were either malignant or had malignant potential, contrary to the previous literature. The Lin-Weiss-Bisceglia criteria are useful in identifying those patients for whom closer surveillance is warranted, because their prognosis is dependent on the Lin-Weiss-Bisceglia diagnosis.
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Affiliation(s)
- John J Kanitra
- Department of Surgery, St. John Hospital and Medical Center, Detroit, MI
| | - John C Hardaway
- Department of Surgery, Roger Williams Medical Center, Providence, RI
| | - Tahereh Soleimani
- Department of Surgery, Michigan State University College of Human Medicine, Lansing, MI
| | - Tracy J Koehler
- Spectrum Health Office of Medical Education, GME, Grand Rapids, MI
| | - Michael K McLeod
- Department of Surgery, Michigan State University College of Human Medicine, Lansing, MI
| | - Srinivas Kavuturu
- Department of Surgery, Michigan State University College of Human Medicine, Lansing, MI.
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Macchi C, Rebuffat P, Blandamura S, Piazza M, Macchi V, Fiore D, Nussdorfer GG. Adrenocortical Oncocytoma: Case Report and Review of the Literature. TUMORI JOURNAL 2018; 84:403-7. [PMID: 9678626 DOI: 10.1177/030089169808400318] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Only 9 oncocytic neoplasms of true adrenal origin have been described to date. It therefore seemed of interest to study the histochemical and ultrastructural features of a non-functioning monolateral adrenocortical oncocytoma which was incidentally detected by ultrasonography and magnetic resonance imaging in a 28-year-old woman. The tumor was round, well encapsulated and weighed 73 g. It consisted of islets of eosinophilic cells, and did not display any sign of necrosis. The proliferation rate (as evaluated by mitotic index and percentage of MIB-1 Ki67 positive cells) was low, and atypic mitoses were absent; some rare cells with nuclear atypias were observed and the capsule was focally invaded by oncocytes. Immunocytochemistry did not show expression of vimentin or cytokeratin. The oncocytes had an abundant cytoplasm packed with mitochondria containing plate-like cristae. Smooth endoplasmic reticulum was virtually absent, while rough endoplasmic reticulum cisternae and free ribosomes were abundant. Although the classic histological approach clearly indicates the benign nature of the tumor, the immunocytochemical and ultrastructural features of oncocytes may suggest their potential for malignant behavior.
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Affiliation(s)
- C Macchi
- Department of Anatomy, University of Padua, Italy
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Wang BY, Gabrilove L, Pertsemlidis D, Gordon RE, Unger PD. Oncocytic Pheochromocytoma with Cytokeratin Reactivity. Int J Surg Pathol 2016. [DOI: 10.1177/106689699700500110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A large hemorrhagic pheochromocytoma (275 g) is described in a 38-year-old obese woman who had no history of sustained or sporadic hypertension. The tumor was unusual histologically because of the striking presence of oncocytic cells. Immunohistochemical studies revealed the positivity for neuron-specific enolase, synaptophysin, and cytokeratin CAM 5.2. Electron microscopy demonstrated neurosecretory dense core granules characteristic of a pheochromocytoma. Oncocytic pheochromocytoma was briefly documented in previous case reports but has not been well recognized. The expression of cytokeratin by pheochromocytoma is also very rare and has been described in a single study in the literature. This case had both unusual clinical and pathologic manifestations and is the first report of a pheochromocytoma with coexistence of oncocytic changes and cytokeratin immunoreactivity.
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Affiliation(s)
- Beverly Y. Wang
- The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, The Mount Sinai Medical Center, New York, N.Y
| | - Lester Gabrilove
- Department of Medicine, The Mount Sinai Medical Center, New York, N.Y
| | | | | | - Pamela D. Unger
- The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, The Mount Sinai Medical Center, New York, N.Y
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6
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A Rare Case of Functioning Adrenocortical Oncocytoma Presenting as Cushing Syndrome. Case Rep Surg 2016; 2016:8964070. [PMID: 26989553 PMCID: PMC4775812 DOI: 10.1155/2016/8964070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/28/2016] [Indexed: 11/17/2022] Open
Abstract
Functioning adrenocortical oncocytoma is very rare neoplasm. It is usually nonfunctional and benign and incidentally detected. Generally, these tumors originate in the kidneys, thyroid, parathyroid, and salivary or pituitary glands; they have also been reported in other sites including choroid plexus, respiratory tract, and larynx. Histologically, they are characterized by cells with eosinophilic granular cytoplasm and numerous packed mitochondria. We reported a case of a 44-year-old female who presented with Cushing syndrome for hypersecretion of cortisol due to adrenocortical oncocytoma. Magnetic resonance of abdomen revealed a right adrenal mass. Laparoscopic adrenalectomy was performed and the tumor was pathologically confirmed as benign adrenocortical oncocytoma. After surgical treatment, Cushing's syndrome resolved.
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Selivanova LS, Abdulkhabirova FM, Voronkova IA, Kuznetsov NS, Troshina EA, Raikhman AO, Birg TM, Tertychnyi AS. [Adrenocortical oncocytoma]. Arkh Patol 2015; 77:55-59. [PMID: 25868370 DOI: 10.17116/patol201577155-] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The paper characterizes adrenocortical oncocytoma, a rare adrenal tumor, accompanied by Cushing's syndrome and estrogen and androgen production and provides histological and immunohistochemical features. The authors describe their observation of a 33-year-old female woman. It is shown that estimation of the malignant potential of adrenocortical oncocytomas requires a special approach and must be done using the Lin-Weiss-Bisceglia criteria.
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Affiliation(s)
- L S Selivanova
- Endocrinology Research Center, Moscow; Academician A.I. Strukov Department of Pathological Anatomy, I.M. Sechenov First Moscow State Medical University, Moscow
| | | | | | | | | | | | - T M Birg
- Academician A.I. Strukov Department of Pathological Anatomy, I.M. Sechenov First Moscow State Medical University, Moscow
| | - A S Tertychnyi
- Academician A.I. Strukov Department of Pathological Anatomy, I.M. Sechenov First Moscow State Medical University, Moscow
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Abstract
This paper reviews the pathologic features of lesions which are oncocytic and involve classic endocrine organs. The history of the oncocytic cell, its morphologic and ultrastructural features, and important immunohistochemical findings are reviewed. Oncocytic proliferations including non-neoplastic and neoplastic of the thyroid, parathyroid, adrenal (both cortex and medulla), and pituitary are described. Their clinical relevance, functional capacity and capability, and where appropriate, prognostic implications are discussed. Important and relevant molecular biological information is included where appropriate.
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9
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Oncocytoma of the adrenal gland medulla. Ann Diagn Pathol 2013; 17:123-6. [DOI: 10.1016/j.anndiagpath.2011.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 07/21/2011] [Indexed: 11/22/2022]
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10
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Mearini L, Del Sordo R, Costantini E, Nunzi E, Porena M. Adrenal oncocytic neoplasm: a systematic review. Urol Int 2012; 91:125-33. [PMID: 23147196 DOI: 10.1159/000345141] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Oncocytic neoplasms as tumors arising in the adrenal glands are rare, usually considered as nonfunctional and benign. In the current literature, there are extremely limited reports of adrenal oncocytic neoplasms; as to date, only 147 cases have been described. The rarity of the event prompted this study which reviews and presents the incidence, histology, diagnosis and therapy of adrenal oncocytic neoplasms. MATERIALS AND METHODS A review by systematic literature search was done using the MEDLINE®/Cochrane libraries from 1950 to date using the medical subject headings 'oncocytoma', 'adrenal gland', 'adrenal oncocytoma', 'adrenal oncocytic neoplasm' and 'adrenal oncocytic carcinoma'. RESULTS Adrenal oncocytic neoplasm is a rare disease, usually incidentally detected because only 17% are functional adrenal masses. The typical oncocyte displays abundant granular eosinophilic cytoplasm, due to the accumulation of mitochondria. Computed tomography and magnetic resonance imaging are not able to identify or differentiate benign and malignant oncocytic neoplasms. The mainstay of therapy is adrenalectomy, recently performed by laparoscopy. The prognosis is good for benign tumors, while adrenocortical oncocytic carcinoma has a poor survival rate of only 5 years. CONCLUSIONS Adrenal oncocytic neoplasm, a rare and mostly benign tumor, usually presents as an incidental, large adrenal mass; surgery is the mainstay of therapy, by means of laparoscopy which is now the most diffuse approach to adrenalectomy.
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Affiliation(s)
- Luigi Mearini
- Urology Department, University of Perugia, Perugia, Italy.
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Al-Zaid T, Alroy J, Pfannl R, Strissel KJ, Powers JF, Layer A, Carpinito G, Tischler AS. Oncocytic adrenal cortical tumor with cytoplasmic inclusions and hyaline globules. Virchows Arch 2008; 453:301-6. [PMID: 18688642 DOI: 10.1007/s00428-008-0634-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 05/05/2008] [Accepted: 05/16/2008] [Indexed: 11/30/2022]
Abstract
Adrenal cortical tumors, particularly oncocytic tumors, have been reported to contain a variety of intracytoplasmic and intramitochondrial inclusions. Oncocytic cortical tumors can also morphologically mimic pheochromocytomas. We report an unusual, partially oncocytic cortical neoplasm with nesting architecture, intranuclear inclusions, and hyaline globules reminiscent of pheochromocytoma, together with numerous, small, brightly eosinophilic, periodic acid-Schiff-positive cytoplasmic inclusions and typical cytoplasmic lipid droplets. Ultrastructural study revealed oncocytes containing numerous mitochondria with intramitochondrial crystals and lipid droplets. Immunohistochemistry and immunoblots were utilized to further characterize the tumor. Immunohistochemistry demonstrated immunoreactivity of both the eosinophilic inclusions and the hyaline globules for adipose differentiation-related protein (ADRP), which is one of a group of proteins associated with storage of neutral lipids in many cell types. Immunoblots confirmed the presence of ADRP and demonstrated an imbalance between ADRP and perilipin, another neutral lipid-associated protein, in tumor tissue compared to normal adrenal cortex. The findings suggest that mitochondrial dysfunction in oncocytic cortical tumors may lead to abnormal processing of proteins related to the lipid-storing functions of the adrenal cortex, resulting in unusual cytoplasmic inclusions and extracellular globules resembling the globules in pheochromocytomas. The finding of ADRP as a constituent of inclusions in adrenal cortical tumors has not been previously reported.
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Affiliation(s)
- Tariq Al-Zaid
- Department of Pathology, Tufts Medical Center, #802, Boston, MA 02111, USA
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12
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Lee SS, Baek KH, Lee YS, Lee JM, Kang MI, Cha BY, Lee KW, Son HY, Kang SK. Subclinical Cushing's syndrome associated with an adrenocortical oncocytoma. J Endocrinol Invest 2008; 31:675-9. [PMID: 18787391 DOI: 10.1007/bf03345624] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Oncocytoma is a neoplasm that can arise in several organs, and it has been more commonly described in the kidney, salivary gland and thyroid. Oncocytoma arising in the adrenal gland is a rare finding. Moreover, functioning adrenocortical oncocytoma is exceptionally rare. A 47-yr-old man was incidentally discovered to have a right adrenal mass. The patient had no clinical features suggestive of increased adrenal function. However, hormonal evaluation showed a disturbed cortisol circadian rhythm, supranormal urinary cortisol excretion, a low level of ACTH, and a lack of suppressibility of cortisol secretion after dexamethasone. Right adrenalectomy was performed, and this revealed a well-circumscribed dark-brown tumor that measured 2.4x2.2 cm. The tumor consisted almost exclusively of large eosinophilic and epitheloid cells whose cytoplasm was packed with eosinophilic granulations, which corresponded to the numerous mitochondria confirmed on electron microscopy. This is a rare case of subclinical Cushing's syndrome that was caused by adrenocortical oncocytoma.
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Affiliation(s)
- S S Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
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Akatsu T, Kameyama K, Araki K, Ashizawa T, Wakabayashi G, Kitajima M. Functioning adrenocortical oncocytoma: the first documented case producing interleukin-6 and review of the literature. J Endocrinol Invest 2008; 31:68-73. [PMID: 18296908 DOI: 10.1007/bf03345569] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Adrenocortical oncocytoma is an extremely rare and predominantly non-functioning tumor. We herein report the first case of an adrenocortical oncocytoma that produces interleukin (IL)-6. A 38-yr-old woman was referred for treatment of a 4-cm adrenal mass. Laboratory test results showed elevated inflammatory parameters. Intriguingly, IL-6 serum level was also high at 30 pg/ml (normal 0-4 pg/ml). The patient underwent laparoscopic right adrenalectomy. Microscopic examination showed that the tumor was an adrenocortical oncocytoma with a unique peripheral lymphoid cuff with germinal centers. Electron microscopy demonstrated that the cytoplasm of the neoplastic cells was packed with numerous abnormal mitochondria. Three observations lead us to consider that this tumor was the primary source of serum IL-6. First, the IL-6 level in blood collected from the right adrenal vein was highest (527 pg/ml) among intra-operative blood samples. Second, neoplastic cells stained positively for IL-6. Third, the serum IL-6 returned to normal levels immediately after surgery.
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Affiliation(s)
- T Akatsu
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160- 8582, Japan.
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15
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Juliano JJ, Cody RL, Suh JH. Metastatic adrenocortical oncocytoma: a case report. Urol Oncol 2007; 26:198-201. [PMID: 18312941 DOI: 10.1016/j.urolonc.2007.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 02/03/2007] [Accepted: 02/08/2007] [Indexed: 11/16/2022]
Abstract
With only 51 cases reported in the literature to date, adrenocortical oncocytoma is an exceedingly rare pathological variant of adrenal neoplasms. The first case of metastatic adrenocortical oncocytoma is reported along with an update of the literature. A role for radiotherapy in the palliative setting is demonstrated.
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Affiliation(s)
- Justin J Juliano
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
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Botsios D, Blouhos K, Vasiliadis K, Asimaki A, Tsalis K, Betsis D. Adrenocortical Oncocytoma — A Rare Tumor of Undefined Malignant Potential: Report of a Case. Surg Today 2007; 37:612-7. [PMID: 17593485 DOI: 10.1007/s00595-006-3458-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 11/18/2006] [Indexed: 10/23/2022]
Abstract
Adrenocortical oncocytomas are exceptionally rare. To our knowledge, only 23 cases have been reported in the world literature, most of which were benign and nonfunctioning. We report a case of adrenocortical oncocytoma diagnosed by pathological examination of an extirpated right adrenal mass in a young woman. We discuss this case and review the literature on this unusual entity.
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Affiliation(s)
- Dimitrios Botsios
- Fourth Department of Surgery, Aristotle University of Thessaloniki, Exohi, 570 10, Thessaloniki, Greece
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Lee R, Al-Ahmadie HA, Boorjian SA, Gonzalez RR, Badillo C, Badillo F, Reuter VE, Steckel J. A case of incidental adrenocortical oncocytoma. ACTA ACUST UNITED AC 2006; 3:618-21. [PMID: 17088930 DOI: 10.1038/ncpuro0631] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 09/12/2006] [Indexed: 11/09/2022]
Abstract
BACKGROUND A 39-year-old female presented with an incidentally discovered left adrenal mass. She denied any history of hypertension, headaches, palpitations, muscle weakness, bruising easily, or fatigue. Physical examination was unremarkable. INVESTIGATIONS Physical examination, laboratory analyses, CT scan and MRI. DIAGNOSIS Oncocytic adrenocortical tumor, or adrenal oncocytoma. MANAGEMENT Adrenalectomy, gross and histopathologic examination, and follow-up radiologic imaging.
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Affiliation(s)
- Richard Lee
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, Starr 900, New York, NY 10021, USA.
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18
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Xiao GQ, Pertsemlidis DS, Unger PD. Functioning adrenocortical oncocytoma: a case report and review of the literature. Ann Diagn Pathol 2005; 9:295-7. [PMID: 16198960 DOI: 10.1016/j.anndiagpath.2005.05.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Adrenocortical oncocytoma is exceptionally rare. Most of these tumors are benign and nonfunctioning. We report a case of functioning adrenocortical oncocytoma located in the right adrenal gland in a 53-year-old woman who presented with Cushing's syndrome. The tumor was small, with exclusively oncocytic histologic features. A discussion of this case and a review of the literature on this entity is presented.
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Affiliation(s)
- Guang-Qian Xiao
- Department of Pathology, Mount Sinai School of Medicine, New York, NY 10029, USA.
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20
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Bisceglia M, Ludovico O, Di Mattia A, Ben-Dor D, Sandbank J, Pasquinelli G, Lau SK, Weiss LM. Adrenocortical oncocytic tumors: report of 10 cases and review of the literature. Int J Surg Pathol 2005; 12:231-43. [PMID: 15306935 DOI: 10.1177/106689690401200304] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Ten additional adrenocortical oncocytic tumors are presented: 2 benign oncocytomas, 4 borderline oncocytomas of uncertain malignant potential, and 4 oncocytic carcinomas. Histologically all tumors were entirely or predominantly composed of oncocytes. Immunohistochemically all tumors were immunoreactive for mitochondrial antigen mES-13. Electron microscopy was performed in 8 cases and was confirmatory of the oncocytic cell change. The morphologic parameters of the Weiss system, considered to be predictive of the biologic behavior of conventional (nononcocytic) adrenocortical tumors, are reviewed in the context of their possible application to the oncocytic tumor variant. Proposed major criteria (high mitotic rate, atypical mitoses, venous invasion) and minor criteria (large size and huge weight, necrosis, capsular invasion, sinusoidal invasion) in distinguishing malignant tumors are discussed, and definitional criteria (predominantly cells with eosinophilic and granular cytoplasm, high nuclear grade, diffuse architectural pattern) in common with all types of oncocytic tumors are outlined. The authors' proposed working rules for diagnostic categorization of oncocytic adrenocortical tumors are defined, with the presence of 1 major criterion indicating malignancy, 1 to 4 minor criteria indicating uncertain malignant potential (borderline), and the absence of all major and minor criteria indicative of benignancy. Using these criteria, the diagnosis of malignancy was straightforward in 3 of the 4 cases designated as oncocytic carcinoma (presence of at least 2 major criteria and all the minor criteria), while in 1 case the original diagnosis of benign oncocytoma was reversed to malignant following critical review of the original pathologic material after local tumor recurrence. Tumor recurrence occurred in 2 carcinomas at 8 and 20 months, respectively, and was followed in 1 case by the patient's death. The third patient expired at 6 months from unrelated causes, and the fourth patient is free of disease at the relatively short follow-up interval of 6 months. Regarding the 4 patients with borderline tumors, all are alive with no evidence of disease, with follow-up ranging from 10 to 61 months (mean 38.7 months). The 2 benign tumors have a follow-up of 25 and 30 months, respectively. Diagnostic difficulties are delineated and a complete review of the literature on this topic has also been performed.
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Affiliation(s)
- Michele Bisceglia
- Department of Pathology, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy
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21
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Song SY, Park S, Kim SR, Suh YL. Oncocytic adrenocortical carcinomas: a pathological and immunohistochemical study of four cases in comparison with conventional adrenocortical carcinomas. Pathol Int 2005; 54:603-10. [PMID: 15260851 DOI: 10.1111/j.1440-1827.2004.01669.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Clinicopathological features of four cases of oncocytic adrenocortical carcinomas were studied. All tumors were large, circumscribed tumors with average size and weight of 11.5 cm and 586 g, respectively. The cut surfaces were yellow or brown and tan with areas of hemorrhage, necrosis, fibrosis, myxoid and cystic change. The tumor cells were exclusively oncocytic with a diffuse or compact and solid arrangement. Nuclear atypia was identified but mitosis was rare. Capsular invasion was identified in all tumors and vascular invasion was identified in one tumor. All tumors were immunoreactive for vimentin and inhibins. Immunoreactivity for pancytokeratin, synaptophysin and S-100 protein was variable and focal. All tumors had low proliferative indices, of less than 1%, and were negative for p53 protein. Ultrastructurally, the cytoplasm of tumor cells showed numerous mitochondria in a compact arrangement. Oncocytic adrenocortical carcinomas showed a similar sex ratio, slightly older mean age, similar left predilection, slightly smaller size and lighter weight compared with the conventional carcinomas. We suggest that most oncocytic adrenocortical carcinomas might be low-grade malignancies with less aggressive histological features compared with conventional carcinomas. However, they should be excised completely because of the likelihood of recurrence and metastasis during the follow-up period.
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Affiliation(s)
- Sang Yong Song
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Abstract
We report the case of an adrenocortical oncocytoma of the left adrenal cortex in a young woman. Physical examination revealed a mass in the left upper quadrant of the abdomen using abdomen ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI), which allowed the identification of a large and inhomogeneous mass between the left kidney and the spleen. The lesion was not endowed of any specific radiologic characteristic nor bysided by any biochemical activity that could allow a radiological presurgical diagnosis. Surgical resection led to the diagnosis of adrenocortical oncocytoma, with no aspects revealing malignant potential.
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Affiliation(s)
- Dario Poretti
- Institute of Radiology, University of Milano, Milan, Italy
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23
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Fadare O, Ma L, Kowalski D. Pathologic quiz case: a 55-year-old woman with an adrenal mass. Arch Pathol Lab Med 2003; 127:e167-8. [PMID: 12653611 DOI: 10.5858/2003-127-e167-pqcayw] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Oluwole Fadare
- Department of Pathology, Yale-New Haven Hospital/Yale University School of Medicine, New Haven, CT 06504, USA.
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24
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Hoang MP, Ayala AG, Albores-Saavedra J. Oncocytic adrenocortical carcinoma: a morphologic, immunohistochemical and ultrastructural study of four cases. Mod Pathol 2002; 15:973-8. [PMID: 12218215 DOI: 10.1038/modpathol.3880638] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We present the clinical, histologic, immunohistochemical, and ultrastructural findings of four cases of non-functioning oncocytic adrenocortical carcinomas. The patients' ages ranged from 39 to 71 years. There was no sex predilection. Large yellow-tan tumors (8.5 to 17.0 cm), well demarcated from the adjacent kidney, were seen with a thin rim of normal adrenal gland along one edge. One tumor invaded the inferior vena cava and extended up to the level of the right atrium, and another metastasized to bone. The other two tumors had similar morphologic features and therefore were considered carcinomas. Histologic sections of all four cases showed a diffuse proliferation of polygonal neoplastic cells with large nuclei containing prominent nucleoli and abundant granular and eosinophilic cytoplasm. Occasional mononuclear and binucleated giant cells were noted in one case. There were rare mitotic figures (less than one per 10 high power fields). All tumors were immunoreactive for cytokeratins (AE1/AE3 and CAM5.2). Inhibin was focally expressed by one tumor and its bone metastasis. Ultrastructurally, the cytoplasm of the neoplastic cells was packed with innumerable mitochondria. Cytologic atypia or mitotic rate cannot reliably predict the biologic behavior of oncocytic adrenocortical neoplasms. Large tumor size (4/4), extracapsular extension (3/4), blood vessel invasion (2/4), necrosis (4/4), and metastasis (1/4) are features of malignancy for oncocytic adrenocortical carcinomas. The treatment of these tumors is complete surgical excision.
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Affiliation(s)
- Mai P Hoang
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
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25
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Chu PG, Weiss LM. Cytokeratin 14 immunoreactivity distinguishes oncocytic tumour from its renal mimics: an immunohistochemical study of 63 cases. Histopathology 2001; 39:455-62. [PMID: 11737302 DOI: 10.1046/j.1365-2559.2001.01273.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS The cytokeratin 14 (CK14) expression in oncocytomas or oncocytic tumours of various tissue origins has not been established. We have studied CK14 expression in 30 cases of oncocytic tumours of various tissue origins and 33 cases of renal cell carcinoma with overlapping features (mimics) by immunohistochemistry. METHODS AND RESULTS Immunohistochemistry (ABC-HRP method) was performed for detection of CK14 in 30 cases of oncocytic tumour and 33 cases of renal mimics. To demonstrate CK14 specificity and sensitivity in oncocytic tumours, mES-13 (an anti-mitochondrial monoclonal antibody) immunohistochemistry was also performed in 20 of 30 cases on oncocytic tumour and all 33 cases of renal mimics. We found that all 30 cases of oncocytic tumour showed cytoplasmic CK14 positivity. All 20 cases of oncocytic tumour studied with mES-13 were positive. CK14 immunoreactivity was identified in only four cases of renal cell carcinoma (one conventional renal cell carcinoma with granular cytoplasm and three chromophobe renal cell carcinomas with eosinophilic cytoplasm). In contrast, all 33 cases of renal cell carcinoma were positive for mES-13 to varying degrees. CONCLUSION The homogeneous, cytoplasmic, and granular CK14 immunoreactivity is sensitive and specific for oncocytic tumours, whereas CK14 immunoreactivity in renal mimics is light and sporadic with peripheral accentuation.
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Affiliation(s)
- P G Chu
- Division of Pathology, City of Hope National Medical Center, Duarte, CA 91010, USA
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26
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Icard P, Louvel A, Le Charpentier M, Chapuis Y. [Adrenocortical tumors with oncocytic cells: benign or malignant?]. ANNALES DE CHIRURGIE 2001; 126:249-53. [PMID: 11340712 DOI: 10.1016/s0003-3944(01)00497-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Adrenocortical tumor with oncocytic cells are exceptional. They are composed exclusively or almost exclusively of oncocytic cells, which are large cells with eosinophilic granulations, corresponding to numerous mitochondria in electronic microscopic examination. This tumor is usually non-functional and benign, and has to be differentiated from the adrenocortical carcinoma.
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Affiliation(s)
- P Icard
- Service de chirurgie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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27
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Krishnamurthy S, Ordóñez NG, Shelton TO, Ayala AG, Sneige N. Fine-needle aspiration cytology of a case of oncocytic adrenocortical carcinoma. Diagn Cytopathol 2000; 22:299-303. [PMID: 10790237 DOI: 10.1002/(sici)1097-0339(200005)22:5<299::aid-dc8>3.0.co;2-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report on the results of fine-needle aspiration cytology of a case of oncocytic adrenocortical carcinoma in a 39-yr-old man. The tumor invaded the inferior vena cava and extended up to the right atrium. Aspirate smears were very cellular and showed a monomorphic population of large polyhedral cells with abundant granular cytoplasm, predominantly distributed singly. Mitotic activity was inconspicuous, and there was no necrosis. Immunohistochemically, the tumor cells were positive for vimentin, cytokeratin, and p53, and negative for synaptophysin, chromogranin, inhibin, and S-100. Ultrastructurally, the cytoplasm of the tumor cells was packed with mitochondria. The patient underwent left radical nephrectomy as well as a combined cardiopulmonary bypass, with atriotomy and resection of the tumor from the right atrium and inferior vena cava. Three months of postoperative follow-up were uneventful.
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Affiliation(s)
- S Krishnamurthy
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
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28
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Izumi T, Kubota Y, Sasagawa I, Itoh K, Nakada T, Kawai K. Adrenal adenoma with foci of oncocytes in a patient with pre-Cushing's syndrome. Int Urol Nephrol 1999; 31:1-6. [PMID: 10408295 DOI: 10.1023/a:1007168819539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A case of unilateral adrenal adenoma with foci of oncocytes in a 64-year-old woman is reported. The tumour manifested clinically pre-Cushing's syndrome with autonomous steroidogenesis which was insufficient to cause typical features of Cushing's syndrome. Whether the pathogenesis of oncocytes and adenoma cells, which were thought to have some metabolic deficiency in the present tumour, are linked remains to be determined.
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Affiliation(s)
- T Izumi
- Department of Urology, Yamagata University School of Medicine, Japan
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29
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Abstract
The histopathology and ultrastructural features of an adrenocortical oncocytoma are reported. The tumour was discovered incidentally during investigation for hypertension in a 72 year old female. Oncocytic tumours of the adrenal cortex are rare, with only 20 examples described in English language reports. Most have been non-functioning and benign, like the present example. Molecular studies may help assess the significance of oncocytic change in the pathogenesis and behaviour of oncocytic neoplasms.
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Affiliation(s)
- P A Kitching
- Department of Histopathology, North Middlesex Hospital, London, UK.
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30
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Lin BT, Bonsib SM, Mierau GW, Weiss LM, Medeiros LJ. Oncocytic adrenocortical neoplasms: a report of seven cases and review of the literature. Am J Surg Pathol 1998; 22:603-14. [PMID: 9591731 DOI: 10.1097/00000478-199805000-00012] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Oncocytic neoplasms of the adrenal gland are rare. We describe the clinicopathologic and immunohistochemical findings of seven oncocytic adrenocortical neoplasms, five oncocytomas, and two oncocytic neoplasms of uncertain malignant potential. Three tumors were studied using electron microscopy. These neoplasms occurred in five women and two men (median age, 55 years) with no clinical evidence that the neoplasms were functional. The size of the neoplasms varied from 5.0 cm to 13.5 cm. Histologically, each neoplasm was composed exclusively of oncocytes. The oncocytomas had very low or absent mitotic activity and no evidence of necrosis. The two oncocytic neoplasms of uncertain malignant potential had increased mitotic activity and necrosis but no evidence of invasion or metastases. Nuclear atypia, either focal or generalized, was found in all neoplasms. Immunohistochemical studies performed using fixed, paraffin-embedded sections showed strong reactivity with the mitochondrial antibody mES-13 in all neoplasms. Four of five oncocytomas and one oncocytic neoplasm of uncertain malignant potential expressed keratin, predominantly keratin 18, as shown using the CAM 5.2 and AE3 antibodies. Two neuroendocrine-associated markers, neuron specific enolase and synaptophysin, were positive in seven and five neoplasms, respectively. However, all neoplasms were negative for the other neuroendocrine markers tested, including chromogranin A, tyrosine hydroxylase, and dopamine beta-hydroxylase, as well as for epithelial membrane antigen, S100, and p53. Using the MIB-1 (Ki-67) antibody, proliferative activity was increased in both oncocytic neoplasms of uncertain malignant potential. All six patients with available clinical follow-up data are alive without evidence disease, although the follow-up interval is relatively short (< 2 years) for the two patients with oncocytic neoplasms of uncertain malignant potential. We conclude that oncocytic adrenocortical neoplasms are nonfunctional tumors that can become large before they are detected by radiologic studies. The majority of neoplasms are benign and should not be misdiagnosed as carcinoma.
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Affiliation(s)
- B T Lin
- Division of Pathology, City of Hope National Medical Center, Duarte, California 91010-0269, USA
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31
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Erlandson RA, Shek TW, Reuter VE. Diagnostic significance of mitochondria in four types of renal epithelial neoplasms: an ultrastructural study of 60 tumors. Ultrastruct Pathol 1997; 21:409-17. [PMID: 9273970 DOI: 10.3109/01913129709021939] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Mitochondrial morphology was studied in 60 renal epithelial neoplasms, including clear cell, papillary, chromophobe cell, and oncocytomas, to see if there are significant differences among the various subtypes. Mitochondria from the nephron tubular system obtained from 36 patients with glomerular diseases served as controls. Significant differences were found in mitochondrial ultrastructure in each of the subtypes of renal epithelial tumors. Novel observations were the presence of tubulovesicular cristae in many of the mitochondria found in chromophobe cell renal carcinomas and the discovery of a possible new oncocytic variant of this entity with mitochondria with pseudotubulovesicular and lamellar cristae similar to those of renal oncocytomas. This latter finding may be of prognostic significance, since renal oncocytomas are benign, while chromophobe cell neoplasms may behave in a malignant fashion.
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Affiliation(s)
- R A Erlandson
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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32
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Roncaroli F, Riccioni L, Cerati M, Capella C, Calbucci F, Trevisan C, Eusebi V. Oncocytic meningioma. Am J Surg Pathol 1997; 21:375-82. [PMID: 9130983 DOI: 10.1097/00000478-199704000-00002] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Six cases of meningioma showing oncocytic changes are described. The lesions were composed mostly of sheets, nests, and cords of large polygonal cells with finely granular eosinophilic cytoplasm rich in mitochondria. Neoplastic cells showed nuclear pleomorphism with prominent nucleoli. Necrosis and high mitotic rate were present in the majority of cases. Oncocytic differentiation was demonstrated by conventional histology, immunocytochemistry, electron microscopy, and Western-blot analysis. Oncocytic meningiomas showed an aggressive behavior; recurrences were observed in three cases, and invasion of brain cortex was evident in other two cases.
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Affiliation(s)
- F Roncaroli
- Department of Clinical Radiology and Anatomic Pathology, University of Bologna, Italy
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33
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Waters PR, Haselhuhn GD, Gunning WT, Phillips ER, Selman SH. Adrenocortical oncocytoma: two case reports and review of literature. Urology 1997; 49:624-8. [PMID: 9111640 DOI: 10.1016/s0090-4295(96)00543-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Oncocytomas of the adrenal gland are rare; only 9 cases are reported in the world literature. We report 2 new cases in which benign adrenal masses were detected during evaluation for microhematuria or flank pain. Subsequent to extirpation of the mass, pathologic examination established the diagnosis of adrenocortical oncocytoma.
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Affiliation(s)
- P R Waters
- Department of Urology, Medical College of Ohio, Toledo 43699-0008, USA
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