1
|
Cardona Attard CD, Gauci Z, Gatt N, Scicluna W, Cachia MJ. Oncocytic adrenocortical tumour presenting as an incidentaloma: a diagnostic challenge. BMJ Case Rep 2022; 15:e250900. [PMID: 36109089 PMCID: PMC9478800 DOI: 10.1136/bcr-2022-250900] [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] [Indexed: 11/04/2022] Open
Abstract
Oncocytic adrenocortical neoplasms are a rare histopathological subtype of adrenal tumours which are usually benign and, if malignant, are less likely to metastasise. We report a case of a non-functioning oncocytic adrenocortical tumour, identified incidentally in a middle-aged woman. It was initially reported as a left-sided 3.5×3.4×5.6 cm adrenal adenoma. It however increased in size to 5.4×4.0×4.3 cm on follow-up scans. Subsequent review of the scans revealed an indeterminate lesion with a precontrast density of 30 Hounsfield units, an absolute washout of 42.6% and a relative washout of 28.6%. As a result, laparoscopic left adrenalectomy was performed. Histology confirmed oncocytic adrenocortical carcinoma when using the Lin-Weiss-Bisceglia system, though it was deemed benign when using the Helsinki scoring system. There has been no evidence of recurrence to date. This case highlights the potential pitfalls in the diagnosis of oncocytic neoplasms and the increased specificity of the Helsinki score in assessing metastatic potential.
Collapse
Affiliation(s)
| | - Zachary Gauci
- Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta
| | - Noel Gatt
- Pathology Department, Mater Dei Hospital, Msida, Malta
| | - Warren Scicluna
- Medical Imaging Department, Mater Dei Hospital, Msida, Malta
| | - Mario J Cachia
- Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Lam AKY. Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging. Biomedicines 2021; 9:biomedicines9020175. [PMID: 33578929 PMCID: PMC7916702 DOI: 10.3390/biomedicines9020175] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 12/20/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a heterogenous group of diseases with different clinical behaviour between adult and paediatric patients. In addition, three histological variants, oncocytic, myxoid and sarcomatoid are noted on the recent World Health Organisation (WHO) classification of ACC. A review of recent literature showed that the different types of ACC have distinctive demographic data, clinical presentation, pathology, biological behaviour, genomic and patients' prognosis. In addition, recent updates of pathology staging for ACC allow refinement of prognostic grouping for planning treatment of the patients with ACC. These advances in genomic, pathology and staging have driven the development of standardisation of pathology reporting. International standardisation of pathological reporting of adrenocortical carcinoma and adaption to local pathology communities provide universal platforms for clinicians and researchers involved in the management of patients with ACC. To conclude, all these advances in the field of pathology will improve development of management strategies including improvement of clinical care, development of prognostic markers and testing of novel therapeutic approaches for patients with adrenocortical carcinoma.
Collapse
Affiliation(s)
- Alfred King-yin Lam
- School of Medicine, Griffith University, Gold Coast, QLD 4222, Australia;
- Pathology Queensland, Gold Coast University Hospital, Southport, Gold Coast, QLD 4215, Australia
- Faculty of Medicine, The University of Queensland, Herston, Brisbane, QLD 4006, Australia
| |
Collapse
|
5
|
Oncocytic subtypes of adrenal cortical carcinoma: Aggressive in appearance yet more indolent in behavior? Surgery 2019; 166:524-533. [PMID: 31472975 DOI: 10.1016/j.surg.2019.05.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/05/2019] [Accepted: 05/19/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Adrenal cortical carcinoma is an aggressive malignancy and typically heralds a poor prognosis. The oncocytic subtype of this neoplasm is rare but may be associated with more favorable outcomes. METHODS The Provincial Cancer Registry was searched for cases of adrenal cortical carcinoma between 1992 and 2017. Comprehensive chart reviews were performed and data gathered related to presentation, treatment, and outcomes. RESULTS In the study, 82 patients with adrenal cortical carcinoma were identified. Complete data were available for 67 patients (82%). In the 41 patients who underwent resection, 9 (22%) had oncocytic subtypes. When compared with the total group of adrenal cortical carcinomas, the oncocytic subtypes were larger at presentation (19.8 cm vs 11.0 cm), more commonly symptomatic and hormonally active, and despite larger tumor size, were often early stage I and II. Recurrent disease was observed in 3 out of 9 oncocytic subtype (vs 23 out of 32 adrenal cortical carcinoma), with greater median time to recurrence (17.5 vs 8 months). Univariate analysis suggested that age, T-stage, M-stage, and overall stage were associated with survival. There was a trend toward improved overall survival for patients with oncocytic subtype on Kaplan-Meier and multivariate analysis. CONCLUSION Despite our small numbers of patients with oncocytic subtype, our data suggest that oncocytic subtype are typically larger at presentation but more often early stage and recur less frequently than adrenocortical carcinomas. Modifications to treatment and surveillance strategies may be appropriate in this subtype.
Collapse
|
6
|
Clinicopathological description of 43 oncocytic adrenocortical tumors: importance of Ki-67 in histoprognostic evaluation. Mod Pathol 2018; 31:1708-1716. [PMID: 29921900 DOI: 10.1038/s41379-018-0077-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/04/2018] [Accepted: 04/08/2018] [Indexed: 11/08/2022]
Abstract
Oncocytic adrenocortical tumors are a rare subtype of adrenal tumors with challenging diagnosis and histoprognostic assessment. It is usually believed that oncocytic adrenocortical tumors have a more indolent clinical behavior than conventional adrenocortical tumors. As the Weiss score overestimates the malignancy of oncocytic adrenocortical tumors owing to intrinsic parameters, alternative scores have been proposed. The Lin-Weiss-Bisceglia score is currently recommended. We performed a large nationwide multicenter retrospective clinicopathologic study of oncocytic adrenocortical tumors. Among the 43 patients in our cohort, 40 patients were alive without disease, 2 patients died of their disease and 1 patient was alive with relapse after a median follow-up of 38 months (20-59). Our data revealed that over 50% of the oncocytic adrenocortical tumor cases were diagnosed as carcinoma whatever the classification systems used, including the Lin-Weiss-Bisceglia score. The exception is the Helsinki score, which incorporates the Ki-67 proliferation index and was the most specific prognostic score for oncocytic adrenocortical tumor malignancy without showing a loss in sensitivity. A comparison of malignant oncocytic adrenocortical tumors with conventional adrenocortical carcinomas matched for age, sex, ENS@T stage and surgical resection status showed significant better overall survival of malignant oncocytic adrenocortical tumors.
Collapse
|
7
|
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
Collapse
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
| |
Collapse
|
8
|
Abstract
Adrenocortical carcinomas are rare tumours that can be diagnostically challenging. Numerous multiparametric scoring systems and diagnostic algorithms have been proposed to differentiate adrenocortical adenoma from adrenocortical carcinoma. Adrenocortical neoplasms must also be differentiated from other primary adrenal tumours, such as phaeochromocytoma and unusual primary adrenal tumours, as well as metastases to the adrenal gland. Myxoid, oncocytic and sarcomatoid variants of adrenocortical tumours must be recognized so that they are not confused with other tumours. The diagnostic criteria for oncocytic adrenocortical carcinoma are different from those for conventional adrenocortical carcinomas. Adrenocortical neoplasms in children are particularly challenging to diagnose, as histological features of malignancy in adrenocortical neoplasms in adults may not be associated with aggressive disease in the tumours of children. Recent histological and immunohistochemical studies and more comprehensive and integrated genomic characterizations continue to advance our understanding of the tumorigenesis of these aggressive neoplasms, and may provide additional diagnostic and prognostic utility and guide the development of therapeutic targets.
Collapse
Affiliation(s)
- Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Vlagea A, Falagan S, Gutiérrez-Gutiérrez G, Moreno-Rubio J, Merino M, Zambrana F, Casado E, Sereno M. Antinuclear antibodies and cancer: A literature review. Crit Rev Oncol Hematol 2018; 127:42-49. [DOI: 10.1016/j.critrevonc.2018.05.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/26/2018] [Accepted: 05/07/2018] [Indexed: 12/22/2022] Open
|
11
|
Abstract
Adrenal gland diagnostics can pose significant challenges. In most academic and community practice settings, adrenal gland resections are encountered less frequently than other endocrine or genitourinary specimens, leading to less familiarity with evolving classifications and criteria. The unique dichotomy between cortical and medullary lesions reflects the developmental evolution of these functionally independent components. Adrenal cortical lesions at resection include hyperplasia, adenoma, and carcinoma, with some cases straddling the boundary between these distinct clinical classifications. The lack of immunohistochemical or molecular markers to definitively categorize these intermediate lesions enhances the diagnostic challenge. In addition, modified terminology for oncocytic and myxoid cortical lesions has been proposed. Medullary lesions are somewhat easier to categorize; however, the prediction of aggressive behavior in pheochromocytomas remains a challenge due to a lack of reliable prognostic biomarkers. Recent work by the Cancer Genome Atlas Project and other research groups has identified a limited subset of molecular and signaling pathway alterations in these 2 major neoplastic categories. Ongoing research to better define prognostic and predictive biomarkers in cortical and medullary lesions has the potential to enhance both pathologic diagnosis and patient therapy.
Collapse
|
12
|
Carré J, Grunenwald S, Vezzosi D, Mazerolles C, Bennet A, Meduri G, Caron P. Virilizing oncocytic adrenocortical carcinoma: clinical and immunohistochemical studies. Gynecol Endocrinol 2016; 32:662-666. [PMID: 26954035 DOI: 10.3109/09513590.2016.1149811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Oncocytic tumors of the adrenal cortex are rare, mostly nonfunctioning and benign. SETTING Report virilizing oncocytic adrenocortical carcinoma in a 50-year-old woman. PATIENT She presented a recent and progressive virilization syndrome, associated with high blood pressure. Hormonal evaluation showed elevated serum testosterone and delta-4-androstenedione levels, normal urinary free cortisol level and incomplete suppression of cortisol at the 1 mg dexamethasone suppression test. CT scan of the abdomen revealed a 35 mm left adrenal mass. INTERVENTION The patient underwent a left adrenalectomy, and the histological study showed a 3 cm oncocytic adrenocortical carcinoma with signs of malignancy. RESULTS Immunohistochemical study revealed that tumor cells expressed the steroidogenic enzymes involved into androgen synthesis (3βHSD and P450c17α), P450 aromatase and luteinizing hormone (LH) receptors. Post-operatively, signs of virilization improved rapidly, serum testosterone and delta-4-androstenedione levels returned to normal, as did the dexamethasone suppression test. During follow-up CT-scan and 18-FDG PET/CT showed a right ovary mass, corresponding to a follicular cyst associated with hyperthecosis. The patient is alive with no recurrence 48 months after adrenal surgery. CONCLUSION Oncocytic adrenocortical carcinomas, although extremely rare, should be considered in women with a virilization syndrome. In this woman immunohistochimical studies revealed the presence of steroidogenic enzymes involved into androgen synthesis and aromatization, and LH receptors could be implicated in this pathology.
Collapse
Affiliation(s)
- Julie Carré
- a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France
| | - Solange Grunenwald
- a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France
| | - Delphine Vezzosi
- a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France
| | | | - Antoine Bennet
- a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France
| | | | - Philippe Caron
- a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France
| |
Collapse
|
13
|
Shenouda M, Brown LG, Denning KL, Pacioles T. A Case of Oncocytic Adrenocortical Neoplasm of Borderline (Uncertain) Malignant Potential. Cureus 2016; 8:e638. [PMID: 27433417 DOI: 10.7759/cureus.638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Oncocytic neoplasms are tumors composed predominantly or exclusively of oncocytes (large polygonal cells with granular eosinophilic cytoplasm due to abnormal mitochondrial accumulation). These tumors are frequently reported in the thyroid, kidneys, and salivary glands. However, they are distinctly rare in the adrenal cortex. Oncocytic adrenocortical neoplasms (OAN) are classified regarding their biological behavior by their histological features according to the Lin-Weiss-Bisceglia system (LWB). Here, we report a case of OAN of borderline or uncertain malignant potential (BMP) with subsequently identified papillary thyroid carcinoma (PTC). A 34-year-old female with a nine-month history of fatigue presented with chest pain. A right adrenal mass was incidentally found while ruling out pulmonary embolism. A CT-guided adrenal biopsy, although not routinely indicated, was performed and interpreted as malignant with no definitive origin. Hormonal workup was unremarkable. PET-scan showed hypermetabolic adrenal mass with peak standardized uptake value of 15, suspicious of malignancy. A hypermetabolic thyroid nodule was also identified, but there was no evidence of metastatic disease. The patient underwent adrenalectomy, and the initial pathology report was interpreted as atypical pink cell tumor. A second pathology report from another laboratory favored OAN based on the morphology and immunohistochemical staining. While the histologic criteria of malignancy were not met, the large tumor size makes it compatible with BMP according to LWB criteria. A follow-up thyroid ultrasound revealed a complex thyroid nodule. A total thyroidectomy was performed, and pathology was consistent with PTC. Of interest, PTC frequently shows an increase in mitochondrial content, which is characteristic of oncocytic tumors. This case illustrates that OAN, although rare, should be considered in the differential diagnosis of adrenal masses. When OAN is identified, it should be classified regarding its biological behavior as benign or malignant using the LWB system and, eventually, the reticulin algorithm of Duregon, et al. Oncocytoma can be confirmed ultrastructurally or by immunohistochemistry. Studying the gene mutations in patients presenting with oncocytic malignancies and other tumors that demonstrate mitochondrial proliferation as PTC might help to understand the role of mitochondrial proliferation in cancer development.
Collapse
Affiliation(s)
- Mina Shenouda
- Internal Medicine, Joan C. Edwards School of Medicine at Marshall University
| | - Linda G Brown
- Pathology Department, Joan C. Edwards School of Medicine at Marshall University
| | - Krista L Denning
- Pathology Department, Joan C. Edwards School of Medicine at Marshall University
| | - Toni Pacioles
- Hematology/Oncology Department, Edwards Comprehensive Cancer Center, Joan C. Edwards School of Medicine at Marshall University
| |
Collapse
|
14
|
Nakamura Y, Yamazaki Y, Felizola SJ, Ise K, Morimoto R, Satoh F, Arai Y, Sasano H. Adrenocortical carcinoma: review of the pathologic features, production of adrenal steroids, and molecular pathogenesis. Endocrinol Metab Clin North Am 2015; 44:399-410. [PMID: 26038208 DOI: 10.1016/j.ecl.2015.02.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adrenocortical carcinoma (ACC) is a malignant neoplasm often associated with an aggressive biological behavior. The histologic differentiation between ACC and adrenocortical adenoma (ACA) is largely determined by employing the Weiss criteria, although this classification may not apply to all the cases. Additionally, various genomic features of ACC could be an auxiliary mode to establish the diagnosis of ACC. Most ACC cases are hormonally functional, and immunohistochemical analysis of steroidogenic enzymes has provided pivotal information as to the analysis of intratumoral production of corticosteroids. This article summarizes the current status of the histopathological diagnosis, molecular pathogenesis, and hormonal features of ACC.
Collapse
Affiliation(s)
- Yasuhiro Nakamura
- Department of Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Yuto Yamazaki
- Department of Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Saulo J Felizola
- Department of Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Kazue Ise
- Department of Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Ryo Morimoto
- Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Fumitoshi Satoh
- Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Yoichi Arai
- Department of Urology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
| |
Collapse
|
15
|
LeBlanc M, Tabrizi M, Kapsner P, Hanson JA. Synchronous adrenocortical neoplasms, paragangliomas, and pheochromocytomas: syndromic considerations regarding an unusual constellation of endocrine tumors. Hum Pathol 2014; 45:2502-6. [PMID: 25288237 DOI: 10.1016/j.humpath.2014.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/09/2014] [Accepted: 08/13/2014] [Indexed: 11/19/2022]
Abstract
The most common clinical syndromes presenting with paragangliomas and/or pheochromocytomas as their endocrine components are multiple endocrine neoplasia type 2, neurofibromatosis, Von Hippel-Lindau syndrome, Carney-Stratakis syndrome, Carney triad, and the recently described hereditary paraganglioma syndrome. Only Carney triad is known to also present with adrenocortical adenomas, currently representing the only described syndrome in which all 3 of the aforementioned tumors are found together. In most cases, prototypical lesions of the triad such as gastrointestinal stromal tumor and pulmonary chondromas are also seen. We present a case of a young woman with synchronous paragangliomas, adrenal/extra-adrenal cortical neoplasms, and pheochromocytoma without genetic mutations for multiple endocrine neoplasia 2, Von Hippel-Lindau syndrome, neurofibromatosis, and succinate dehydrogenase. We speculate that this represents a previously undescribed presentation of Carney triad and, at the very least, indicates the need for monitoring for the development of other tumors of the triad.
Collapse
Affiliation(s)
- Melissa LeBlanc
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM 87131
| | - Mohsen Tabrizi
- Department of Endocrinology, Diabetes, and Metabolism, University of New Mexico School of Medicine, Albuquerque, NM 87131
| | - Patricia Kapsner
- Department of Endocrinology, Diabetes, and Metabolism, University of New Mexico School of Medicine, Albuquerque, NM 87131
| | - Joshua Anspach Hanson
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM 87131.
| |
Collapse
|
16
|
Else T, Kim AC, Sabolch A, Raymond VM, Kandathil A, Caoili EM, Jolly S, Miller BS, Giordano TJ, Hammer GD. Adrenocortical carcinoma. Endocr Rev 2014; 35:282-326. [PMID: 24423978 PMCID: PMC3963263 DOI: 10.1210/er.2013-1029] [Citation(s) in RCA: 553] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy, often with an unfavorable prognosis. Here we summarize the knowledge about diagnosis, epidemiology, pathophysiology, and therapy of ACC. Over recent years, multidisciplinary clinics have formed and the first international treatment trials have been conducted. This review focuses on evidence gained from recent basic science and clinical research and provides perspectives from the experience of a large multidisciplinary clinic dedicated to the care of patients with ACC.
Collapse
Affiliation(s)
- Tobias Else
- MEND/Division of Metabolism, Endocrinology, and Diabetes (T.E., T.J.G., G.D.H.), Division of Molecular Medicine and Genetics (V.M.R.), Department of Internal Medicine; Departments of Radiation Oncology (A.S., J.S.), Pathology (T.J.G.), and Radiology (A.K., E.M.C.); and Division of Endocrine Surgery (B.S.M.), Section of General Surgery, (A.C.K.), Department of Surgery, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan 48109
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Recurrence of a functional adrenocortical oncocytoma of borderline malignant potential showing high FDG uptake on 18F-FDG PET/CT. Ann Nucl Med 2013; 28:69-73. [DOI: 10.1007/s12149-013-0764-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
|
18
|
|
19
|
Gruber-Dujardin E, Jurczynski K, Kaup FJ, Mätz-Rensing K. Oncocytic adrenocortical carcinoma in a putty-nosed monkey (Cercopithecus nictitans) with hyperadrenocorticism. J Comp Pathol 2013; 149:509-13. [PMID: 23746483 DOI: 10.1016/j.jcpa.2013.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 03/17/2013] [Accepted: 04/06/2013] [Indexed: 11/25/2022]
Abstract
Oncocytic adrenocortical tumours are rare in man and have never been described in non-human primates. An oncocytic adrenocortical carcinoma was identified in an 18-year-old female putty-nosed monkey (Cercopithecus nictitans) with hyperadrenocorticism and invasive aspergillosis. Microscopically, the tumour consisted of large cells with abundant eosinophilic, granular cytoplasm containing numerous mitochondria as identified by electron microscopy. Tumour cells had large nuclei with occasional intranuclear cytoplasmic pseudoinclusions. Immunohistochemically, tumour cells expressed vimentin, synaptophysin and neuron-specific enolase, while they were negative for cytokeratin, chromogranin-A, melan-A and S100.
Collapse
|
20
|
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.
Collapse
Affiliation(s)
- Luigi Mearini
- Urology Department, University of Perugia, Perugia, Italy.
| | | | | | | | | |
Collapse
|
21
|
Ectopic functioning adrenocortical oncocytic adenoma (oncocytoma) with myelolipoma causing virilization. Case Rep Pathol 2012; 2012:326418. [PMID: 23094172 PMCID: PMC3474228 DOI: 10.1155/2012/326418] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 09/09/2012] [Indexed: 11/27/2022] Open
Abstract
Functioning adrenal adenomas are well-described entities that can rarely occur outside the adrenal gland in the ectopic adrenal tissue. Similarly, myelolipoma is an another benign lesion of the adrenal tissue which can rarely occur outside the adrenal gland. We report the first case of a testosterone producing an extra-adrenal adrenocortical oncocytoma accompanied by a myelolipoma. The patient presented with virilization and elevated androgen levels. Imaging revealed a retroperitoneal mass, which histologically consisted of oncocytes and intermingled myelolipoma. Postoperative androgen levels decreased to normal. The tumor cells were strongly positive for inhibin and Melan-A, supporting the adrenal origin. This case demonstrates a diagnostic challenge in which correlation with histology, immunohistochemistry, and serum endocrine studies led to the final diagnosis.
Collapse
|
22
|
Shastri C, Rana C, Kumari N, Agarwal G, Krishnani N. Bilateral adrenocortical oncocytoma with bilateral myelolipomatous metaplasia. Endocr Pathol 2012; 23:112-4. [PMID: 22350762 DOI: 10.1007/s12022-012-9198-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Charu Shastri
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, U.P., India
| | | | | | | | | |
Collapse
|
23
|
Oncocytic Adrenal Cortical Carcinosarcoma With Pleomorphic Rhabdomyosarcomatous Metastases. Am J Surg Pathol 2012; 36:470-7. [DOI: 10.1097/pas.0b013e31824517d9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
de Krijger RR, Papathomas TG. Adrenocortical neoplasia: evolving concepts in tumorigenesis with an emphasis on adrenal cortical carcinoma variants. Virchows Arch 2012; 460:9-18. [PMID: 22086150 PMCID: PMC3267029 DOI: 10.1007/s00428-011-1166-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 09/28/2011] [Accepted: 10/31/2011] [Indexed: 12/16/2022]
Abstract
Adrenocortical carcinoma (ACC) is a rare, heterogeneous malignancy with a poor prognosis. According to WHO classification 2004, ACC variants include oncocytic ACCs, myxoid ACCs and ACCs with sarcomatous areas. Herein, we provide a comprehensive review of these rare subtypes of adrenocortical malignancy and emphasize their clinicopathological features with the aim of elucidating aspects of diagnostic categorization, differential diagnostics and biological behavior. The issue of current terminology, applied to biphasic tumors with pleomorphic, sarcomatous or sarcomatoid elements arising in adrenal cortex, is also discussed. We additionally present emerging evidence concerning the adrenal cortical tumorigenesis and the putative adenoma-carcinoma sequence as well.
Collapse
Affiliation(s)
- Ronald R. de Krijger
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC—University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Thomas G. Papathomas
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC—University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| |
Collapse
|
25
|
|
26
|
Lee CK, Choi KH, Cha YJ, Bum JH, Lee HH, Kim MS, Park WK, Yang SC, Han WK. Large oncocytic adrenocortical tumor with uncertain malignant potential. Korean J Urol 2011; 52:650-2. [PMID: 22025964 PMCID: PMC3198242 DOI: 10.4111/kju.2011.52.9.650] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 08/02/2011] [Indexed: 11/18/2022] Open
Abstract
Oncocytoma is a neoplasm consisting of oncocytes that is found in the salivary gland, kidney, and thyroid. Adrenocortical oncocytoma is particularly uncommon, and most cases reported are benign and nonfunctioning. Here, we report a 20 cm adrenal mass associated with necrosis that was identified as an oncocytic adrenocortical tumor with uncertain malignant potential through histopathological evaluation after its resection.
Collapse
Affiliation(s)
- Chang Ki Lee
- Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Guaraldi F, Zang G, Dackiw AP, Caturegli P. Oncocytic mania: a review of oncocytic lesions throughout the body. J Endocrinol Invest 2011; 34:383-94. [PMID: 21301204 DOI: 10.1007/bf03347464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Oncocytic lesions are characterized pathologically by an abundance of oncocytes, that is by enlarged, eosinophilic, and finely granular cells enriched in mitochondria. They can arise in numerous organs and tissues, often in endocrine glands, and have been associated with hyperplasia, autoimmunity, and neoplasia. The causes and mechanisms that transform a normal cell into an oncocyte remain to be elucidated. Aim of this article is to review the most common oncocytic lesions, highlighting their key pathological features and clinical significance.
Collapse
Affiliation(s)
- F Guaraldi
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | |
Collapse
|
28
|
Wong DD, Spagnolo DV, Bisceglia M, Havlat M, McCallum D, Platten MA. Oncocytic adrenocortical neoplasms—a clinicopathologic study of 13 new cases emphasizing the importance of their recognition. Hum Pathol 2011; 42:489-99. [DOI: 10.1016/j.humpath.2010.08.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 08/17/2010] [Accepted: 08/25/2010] [Indexed: 11/25/2022]
|