Ectopic adrenal gland in an adult inguinal hernial sac: A case report

Ectopic adrenal tissue in the mesosalpinx of an older female: the fourth case report in the literature

Ectopic adrenal tissue is a rare finding often encountered incidentally during histopathological examinations. The most common site is the genitourinary tract and pelvis, and more frequently in males than females. Ectopic adrenal tissue is primarily found in neonates and is extremely rare in adults. Although it is an unexpected entity, pathologists should be aware of it because it may be confused with metastasis of clear cell renal carcinoma. To the best of our knowledge, only three cases of ectopic adrenal tissue in the mesosalpinx of the fallopian tube have been reported in the medical literature, making this case the fourth one. In our report, we discussed an ectopic adrenal tissue that was discovered incidentally in the mesosalpinx of an older female.

A rare case of ectopic adrenal gland in an adult inguinal cord lipoma: Case report and literature review

INTRODUCTION

Ectopic adrenocortical tissue is defined as the presence of accessory adrenal cortex tissue outside the suprarenal location of the adrenal glands. It is not an infrequent finding during inguinal operations in infants, however, its incidence in adults is found to be less than 1 %.

CASE

We report a case of ectopic adrenal tissue incidentally found in a cord lipoma of a 68-year-old man, presenting for elective inguinal hernia repair.

CLINICAL DISCUSSION

In the literature, the majority of cases of ectopic adrenocortical tissue are reported during groin surgeries in children. After the first few years of life, it normally regresses, but in a few uncommon cases like ours, it might continue long into adulthood. The condition can have several theoretical clinical implications that need to be considered by surgeons. Adrenal insufficiency can occur if the ectopic adrenal tissue is the only adrenal tissue in the patient along with a potential for neoplastic transformation in cases of persistence of ectopia.

CONCLUSION

However, studies have shown no evidence of endocrine or oncologic complications after excision or persistence of the ectopic adrenal gland. Consequently, no investigations or treatments are indicated.

Serous Cystadenoma with Ectopic Adrenal Cell Rest of Ovary: A Rare Case Report

Ectopic adrenal tissue is an uncommon entity in females. It is usually seen in male children, and the commonly involved sites are the kidney, retroperitoneum, spermatic cord, and paratesticular region. The ectopic adrenal gland in adults has been described in few studies only. Ectopic adrenal tissue was diagnosed as an incidental finding in histopathological examination of serous cystadenoma of the ovary. A 44-year-old female presented with a complaint of vague abdominal discomfort for the past few months. Ultrasound was suggestive of a left ovarian complex cystic lesion. The histopathological examination revealed serous cystadenoma with ectopic adrenal cell rest. Here, we present this case as it is a rare finding incidentally detected in a patient being operated on for a different pathology.

Adrenal Rests in the Uro-genital Tract of an Adult Population

Ectopic adrenal rests are a rare condition which can be found in various sites, generally in the retroperitoneum or pelvis along the path of gonadal descent. Their real prevalence is unknown. Males are more commonly affected, at least in the pediatric age. Adrenal rests are usually clinically silent and incidentally found in surgical samples, mostly in the pediatric population, and rarely in adults. With the aim of increasing knowledge and estimating the prevalence of ectopic adrenocortical tissue in the adult population, 44 adrenal rests in the urogenital tract of 40 adults are described. These represent approximately 0.07% of the total number of urogenital and gynecological surgeries performed in the 22 considered years. Adrenal rests were identified in the spermatic cord (10 males) and in paraovarian, parasalpingeal, or infundibulopelvic ligament locations (30 females). All but one was incidental findings. One case regarded an adrenocortical carcinoma arisen in adrenal rests. A literature review of adrenal ectopia in the urogenital tract of adults identified 57 reported cases from 53 patients, with similar clinicopathological features as those of our series, with the exception of a lower incidence of parasalpingeal locations. Despite their limited clinical implications, awareness of ectopic adrenal rests is essential also in adults for at least two reasons: (a) to correctly identify sources of adrenocortical hormone production in case of adrenal insufficiency or hormonal imbalance and (b) to avoid misinterpretations in the diagnostic workup of renal cell carcinoma, adrenocortical tumors, and rare gonadal neoplasms, including Sertoli/Leydig cell tumors.

Adrenal Cortical Rests in the Fallopian Tube: Report of a Case and Review of the Literature

We report an extremely unusual finding discovered incidentally during a routine pathologic evaluation of a fallopian tube, surgically removed on the grounds of ectopic pregnancy. We came across a minute yellowish nodule situated within the wall of the salpinx, which corresponded to ectopic adrenal cortex, as verified by microscopical examination, and coexisted with salpingitis isthmica nodosa. A research of the available English literature on this subject confirmed the rareness of the entity we encountered. This case is presented because of its uniqueness, aiming to raise awareness of a rare condition which is discussed along with potential diagnostic dilemmas, its prognostic significance, and possible complications.