1
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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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Chen XC, Tang YM, Mao Y, Qin DR. Oncocytic adrenocortical tumor with uncertain malignant potential in pediatric population: A case report and review of literature. World J Clin Cases 2021; 9:5675-5682. [PMID: 34307624 PMCID: PMC8281429 DOI: 10.12998/wjcc.v9.i20.5675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/25/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Oncocytic adrenocortical tumor (OACT) is rare, with few cases reported in the literature. No more than 20 cases in children have been reported. The clinical characteristics, diagnosis, treatment and prognosis of children with OACT are summarized based on a literature review, in order to improve the understanding of OACT in children.
CASE SUMMARY We report a case of a 17-mo-old patient who was admitted to our hospital due to symptoms of odynuria and fever, which are clinical features consistent with a functional adrenocortical tumor. The patient was diagnosed with OACT of uncertain malignant potential. Computed tomography indicated a soft tissue giant tumor in the right adrenal region, approximately 4.3 cm × 5.5 cm in size. Multiple nodular and speckled calcifications were observed in the lesion. The patient received robot-assisted laparoscopic right adrenal tumor resection. Postoperative pathological results were consistent with OACT, and immunohistochemical results showed cytokeratin+/-, chromogranin A+, synaptophysin-, neuron-specific enolase-, S100-, Ki67 about 10%, CD34- and D2-40-. After surgery, urinary tract ultrasonography was reviewed monthly, catecholamine hormone and sex hormone levels were examined every 2 mo and computed tomography was performed every 6 mo. To date, no tumor metastasis or recurrence has been identified in this patient. The levels of sex hormones and catecholamine hormones decreased to normal 1 mo after surgery.
CONCLUSION OACT is rare in the pediatric population, with few cases reported in the literature. Although most pediatric OACTs are benign, malignant cases have been reported. Surgical resection is the preferred option in most patients.
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Affiliation(s)
- Xiao-Chun Chen
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China
| | - Yun-Man Tang
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China
| | - Yu Mao
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China
| | - Dao-Rui Qin
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China
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3
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Madi LR, Fisch Shvalb N, Sade Zaltz C, Levy-Shraga Y. Central precocious puberty after resection of a virilising adrenocortical oncocytic tumour. BMJ Case Rep 2021; 14:14/5/e239562. [PMID: 34045190 DOI: 10.1136/bcr-2020-239562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adrenocortical oncocytic tumours are a histological subtype of adrenal neoplasms with a distinctive morphological appearance. Since these tumours are composed of cells of the adrenal cortex, they may act as functional tumours with excess hormone production. They may cause Cushing's syndrome, inappropriate virilisation or precocious puberty. Though rare during childhood, adrenocortical oncocytic tumours should be suspected in a child with peripheral precocious puberty and marked elevation of dehydroepiandrosterone sulfate levels. We describe a 6-year girl who presented with peripheral precocious puberty due to a functional adrenocortical oncocytic tumour. Three months after tumour removal, she developed true central precocious puberty. This report highlights that peripheral precocious puberty may trigger central precocious puberty, particularly after resolution of the underlying cause of the peripheral precocious puberty.
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Affiliation(s)
- Lee Rima Madi
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Naama Fisch Shvalb
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,The Jesse and Sara Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Chen Sade Zaltz
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,The Department of Pathology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Yael Levy-Shraga
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel .,The Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
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4
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Kim EI, Mamedova EO, Selivanova LS, Buryakina SA, Gorbunova NP, Latkina NV, Kuznetsov NS, Belaya ZE. [Cushing's syndrome due to bilateral oncocytic adrenal tumor]. ACTA ACUST UNITED AC 2020; 66:47-55. [PMID: 33351338 DOI: 10.14341/probl12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/19/2020] [Accepted: 07/03/2020] [Indexed: 11/06/2022]
Abstract
Cushing’s syndrome accounts for approximately 20–30% of endogenous hypercortisolism cases, and adrenal involvement can be either unilateral or bilateral. Cushing’s syndrome due to bilateral adrenal tumors is extremely rare. Adrenal oncocytomas are another rare cause of endogenous hypercortisolism: about 13 cases are described in the literature. Oncocytomas are rare epithelial neoplasms, characterized by abnormally excessive accumulation of defective mitochondria in the cytoplasm of cells, and make up 1.8% of all adrenal neoplasms. We describe a 58-year old patient with Cushing’s syndrome and bilateral adrenal tumors. Multispiral computed tomography of the adrenals showed signs suspicious of lipid-poor atypical adenomas or malignant tumors. Surgical treatment was the method of choice, and the larger tumor was excised first. Due to the absence of remission of endogenous hypercortisolism the excision of the second tumor was performed. Morphological and immunohistochemical examination confirmed the diagnosis of bilateral oncocytic adrenocortical tumors with uncertain malignant potential. Cases of bilateral hormone-producing adrenal oncocytomas have not been described in the literature.
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Al Badi MK, Al-Alwan I, Al-Dubayee M, Al-Anzi A, Al Turki MS, Aloudah N, Alsaad KO. Testosterone- and Cortisol-secreting Oncocytic Adrenocortical Adenoma in the Pediatric Age-group. Pediatr Dev Pathol 2018; 21:568-573. [PMID: 29426273 DOI: 10.1177/1093526617753045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Oncocytic tumors are epithelial neoplasms that occur in various organs, including adrenal glands. Oncocytic adrenocortical adenomas and carcinomas are uncommon but well-known pathological entities in adults. However, generally oncocytic tumors, particularly in the adrenal glands, are very rare in the pediatric age-group. Most oncocytic adrenal tumors are not functional. We present a rare case of right-sided, functional oncocytic adrenocortical adenoma in a 5-year-old boy, who presented with clinical manifestations of precocious puberty and Cushing syndrome. Laparoscopic adrenalectomy showed a well-defined mass weighing 8.4 g and measuring 3 cm in maximum dimension. Histological examination demonstrated no features suggestive of aggressive biological behavior. The patient showed no evidence of recurrent or metastatic disease and continued to have normal serum hormonal levels 28 months following the surgery. In this report, we discuss the clinicopathological characteristics of this rare pathological entity and briefly review the literature on functional oncocytic adrenal tumors in the pediatric population.
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Affiliation(s)
- Maryam K Al Badi
- 1 Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,2 Department of Pediatric Endocrinology, National Diabetes and Endocrine Centre, Royal Hospital, Oman
| | - Ibrahim Al-Alwan
- 1 Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,3 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Al-Dubayee
- 1 Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,3 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ayed Al-Anzi
- 4 Department of Pediatrics, Al Jahra Hospital, Kuwait City, Kuwait
| | - Maram S Al Turki
- 3 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Noura Aloudah
- 3 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,5 Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Khaled O Alsaad
- 3 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,5 Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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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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Costanzo PR, Paissan AL, Knoblovits P. Functional plurihormonal adrenal oncocytoma: case report and literature review. Clin Case Rep 2017; 6:37-44. [PMID: 29375834 PMCID: PMC5771899 DOI: 10.1002/ccr3.1279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 09/24/2017] [Accepted: 09/30/2017] [Indexed: 02/01/2023] Open
Abstract
We present a 27-year-old woman with an adrenal oncocytoma. This is a very rare entity. We provide a review of the clinical, biochemical and pathological features of cases reported in the literature.
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Affiliation(s)
- Pablo René Costanzo
- Servicio de Endocrinología, Metabolismo y Medicina Nuclear Hospital Italiano de Buenos Aires Buenos Aires Argentina
| | - Andrea Laura Paissan
- Servicio de Endocrinología, Metabolismo y Medicina Nuclear Hospital Italiano de Buenos Aires Buenos Aires Argentina
| | - Pablo Knoblovits
- Servicio de Endocrinología, Metabolismo y Medicina Nuclear Hospital Italiano de Buenos Aires Buenos Aires Argentina
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Tetsi Nomigni M, Ouzounian S, Benoit A, Vadrot J, Tissier F, Renouf S, Lefebvre H, Christin-Maitre S, Louiset E. Steroidogenic enzyme profile in an androgen-secreting adrenocortical oncocytoma associated with hirsustism. Endocr Connect 2015; 4:117-27. [PMID: 26034121 PMCID: PMC4453718 DOI: 10.1530/ec-15-0014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/27/2015] [Indexed: 11/08/2022]
Abstract
Hirsutism induced by hyperandrogenism can be associated with polycystic ovary syndrome, 21-hydroxylase (OH) deficiency or androgen-secreting tumors, including ovarian and adrenal tumors. Adrenal androgen-secreting tumors are frequently malignant. Adrenal oncocytomas represent rare causes of hyperandrogenism. The aim of the study was to investigate steroidogenic enzyme expression and steroid secretion in an androgen-secreting adrenal oncocytoma in a young woman presenting with hirsutism. Hyperandrogenism was diagnosed on the basis of elevated plasma Δ4-androstenedione and testosterone levels. Pelvic ultrasound was normal, CT scanning revealed a right adrenal mass. Androgens were assessed in adrenal and ovarian vein samples and proved a right adrenal origin. Adrenalectomy normalized androgen levels and the adrenal tumor was diagnosed as an oncocytoma. Real time-PCR, immunohistochemistry and cell culture studies were performed on tumor explants to investigate the steroid secretion profile. Among enzymes required for cortisol synthesis, 17α-OH and 3β-hydroxysteroid dehydrogenase 2 (3β-HSD2) were highly expressed whereas 21-OH and 11β-OH were weakly produced at the mRNA and/or protein levels. Enzymes involved in testosterone production, 17β-HSD5 and 17β-HSD3, were also detected. ACTH receptor was present in the tissue. Cortisol, Δ4-androstenedione and testosterone secretions by cultured cells were increased by ACTH. These results provide the first demonstration, to our knowledge, of abnormal expression profile of steroidogenic enzymes in an adrenocortical oncocytoma. Our results also indicate that Δ4-androstenedione hypersecretion resulted from high 17α-OH and 3β-HSD2 expression in combination with low expression of 21-OH and 11β-OH. Testosterone production was ascribed to occurrence of 17β-HSD5 and 17β-HSD3. Finally, our results indicate that androgen secretion was stimulated by ACTH.
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Affiliation(s)
- Milène Tetsi Nomigni
- INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont-Saint-Aignan, France
- University of Rouen, Mont-Saint-Aignan, France
| | - Sophie Ouzounian
- Department of Endocrinology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alice Benoit
- Department of Endocrinology, Diabetes and Metabolic Diseases, Hôpital Sud Francilien, Corbeil-Essonnes, France
| | - Jacqueline Vadrot
- Department of Pathology, Hôpital Sud Francilien, Corbeil-Essonnes, France
| | - Frédérique Tissier
- Department of Pathology, Assistance Publique des Hôpitaux de Paris, Hôpital Pitié Salpétrière Pierre-et-Marie Curie University, Paris, France
| | - Sylvie Renouf
- INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont-Saint-Aignan, France
- University of Rouen, Mont-Saint-Aignan, France
| | - Hervé Lefebvre
- INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont-Saint-Aignan, France
- University of Rouen, Mont-Saint-Aignan, France
- Department of Endocrinology, Diabetes and Metabolic Diseases, Rouen University Hospital, 76000, Rouen, France
- Correspondence should be addressed to H Lefebvre
| | - Sophie Christin-Maitre
- Department of Endocrinology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, U933, Paris, France
| | - Estelle Louiset
- INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont-Saint-Aignan, France
- University of Rouen, Mont-Saint-Aignan, France
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9
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Abstract
In daily routine pathology of the adrenal glands three tumor entities are important: adrenocortical tumors, adrenomedullary tumors and metastases. The differentiation of these three main tumor types can often be difficult structurally but immunostaining enables a definite diagnosis in nearly all cases. Adrenocortical tumors are positive for steroidogenic factor 1 and melan-A and always negative for chromogranin A whereas adrenomedullary tumors express chromogranin A but never keratin. A broad spectrum of antibodies is available for the identification of metastases and even the rare epithelioid angiosarcomas. For adrenocortical tumors, adenomas and carcinomas can be differentiated using three scoring systems and the Ki-67 index in adenomas should not exceed 3%. Using scoring systems and the Ki-67 index approximately 90% of cortical tumors can be differentiated into benign or malignant tumors. For pheochromocytomas two scoring systems are used for differentiating benign and malignant tumors but the results are less dependable.
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Affiliation(s)
- W Saeger
- Institut für Pathologie der Universität Hamburg, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Deutschland,
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