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Ji J, Zhong H, Ren X, He T, Xie G, Wang X. Bronchoscopic treatment of multiple bronchial myelolipomas: a case report and literature review. BMC Pulm Med 2023; 23:317. [PMID: 37653374 PMCID: PMC10472584 DOI: 10.1186/s12890-023-02608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/20/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Extra-adrenal myelolipoma is an unusual entity, and endobronchial myelolipoma is rarer, which is often ignored by clinicians, delaying the disease and affecting the prognosis. CASE PRESENTATION A 71-year-old man with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus, with recurrent fever, cough, and expectoration for more than 2 weeks experienced relief in cough, phlegm reduction, and glycemic control with anti-inflammatory treatment. Further examination revealed that new growths obstructing all lobar bronchi impaired flexible bronchoscope entry. In order to relieve the patient's symptoms, under general anesthesia, we performed liquid nitrogen cryobiopsy at multiple bronchial openings, and then used argon plasma coagulation (APC) to achieve hemostasis. The pathological diagnosis was bronchial myelolipoma. The largest volume of the resected tissue was a mass measuring 0.6 cm × 0.4 cm × 0.3 cm at the bronchial opening of the upper lobe of the left lung. The patient's condition was stable and the symptoms were partially relieved after surgery. No recurrence was observed during the 12-month follow-up, although the long-term treatment efficacy is unknown. CONCLUSION Pathological biopsy is key to the diagnosis of endobronchial myelolipoma, and the development of the endobronchial myelolipomas may have been associated with long-term poor control of steroid levels in this patient.
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Affiliation(s)
- Jiali Ji
- Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Jiangsu, China
| | - Hongqin Zhong
- Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Jiangsu, China
| | - Xian Ren
- Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Jiangsu, China
| | - Ting He
- Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Jiangsu, China
| | - Guijuan Xie
- Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Jiangsu, China
| | - Xun Wang
- Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Jiangsu, China.
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Liao Z, Gao Y, Zhao Y, Wang Z, Wang X, Zhou J, Zhang Y. Pure androgen-secreting adrenal tumor (PASAT): A rare case report of bilateral PASATs and a systematic review. Front Endocrinol (Lausanne) 2023; 14:1138114. [PMID: 37033242 PMCID: PMC10075358 DOI: 10.3389/fendo.2023.1138114] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Adult pure androgen-secreting adrenal tumors (PASATs) are extremely rare, and their characteristics are largely unknown. METHODS A rare case of adult bilateral PASATs was reported, and a systematic literature review of adult PASATs was conducted to summarize the characteristics of PASATs. RESULTS In total, 48 studies, including 40 case reports and 8 articles, were identified in this review. Analysis based on data of 42 patients (including current case and 41 patients from 40 case reports) showed that average age was 40.48 ± 15.80 years (range of 18-76). The incidence of adult PASAT peaked at 21-30 years old, while that of malignant PASAT peaked at 41-50 years old. Most PASAT patients were female (40/42, 95.23%), and hirsutism was the most common symptom (37/39, 94.87%). Testosterone (T) was the most commonly elevated androgen (36/42, 85.71%), and 26 of 32 tested patients presented increased dehydroepiandrosterone sulfate (DS) levels. In malignancy cases, disease duration was significantly decreased (1.96 vs. 4.51 years, P=0.025), and tumor diameter was significantly increased (8.9 vs. 4.9 cm, p=0.011). Moreover, the androgen levels, namely, T/upper normal range limit (UNRL) (11.94 vs. 4.943, P=0.770) and DS/UNRL (16.5 vs. 5.28, P=0.625), were higher in patients with malignancy. In total, 5 out of 7 patients showed an increase in DS or T in the human chorionic gonadotropin (HCG) stimulation test. Overall, 41 out of 42 patients (including current case) underwent adrenal surgery, and recurrence, metastasis, or death was reported in 5 out of 11 malignant patients even with adjuvant or rescue mitotane chemotherapy. CONCLUSION Adult PASAT, which is predominant in women, is characterized by virilism and menstrual dysfunction, especially hirsutism. Elevated T and DS may contribute to the diagnosis of adult PASAT, and HCG stimulation test might also be of help in diagnosis. Patients with malignant PASAT have a shorter disease duration, larger tumor sizes and relatively higher androgen levels. Surgery is recommended for all local PASATs, and Malignancy of PASAT should be fully considered due to the high risk of malignancy, poor prognosis and limited effective approaches.
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Affiliation(s)
- Zhangcheng Liao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuting Gao
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhan Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xu Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jiaquan Zhou
- Department of Urology, Hainan General Hospital, Haikou, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Yushi Zhang,
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Singh Y, Bharti JN, Vishnoi JR. Serous Cystadenoma with Ectopic Adrenal Cell Rest of Ovary: A Rare Case Report. J Midlife Health 2022; 13:325-327. [PMID: 37324793 PMCID: PMC10266566 DOI: 10.4103/jmh.jmh_156_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/30/2022] [Accepted: 01/25/2023] [Indexed: 06/17/2023] Open
Abstract
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.
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Affiliation(s)
- Yasmeen Singh
- Department of Pathology, AIIMS, Jodhpur, Rajasthan, India
| | | | - Jeewan Ram Vishnoi
- Department of Surgical Oncology, AIIMS Surgical Oncology, Jodhpur, Rajasthan, India
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Kotidis E, Bitsianis S, Galanos-Demiris K, Christidis P, Mantzoros I, Ioannidis O, Foutsitzis V, Pramateftakis MG, Aggelopoulos S. Case Report: A Virilizing Adrenal Oncocytoma. Front Surg 2021; 8:646459. [PMID: 33829037 PMCID: PMC8019906 DOI: 10.3389/fsurg.2021.646459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/19/2021] [Indexed: 11/24/2022] Open
Abstract
A 64-year-old female was admitted to our clinic with a 9-cm-sized adrenal mass. The patient's main symptom was hirsutism, which included thinning scalp hair and excessive hair growth over her torso and arms. Upon investigation, elevated values of testosterone, androsterone D4, and DHEA-S were found. Contrast-enhanced abdominal CT and MRI scans revealed a heterogenous large mass (diameter 9 × 8.5 cm) with focal calcifications, necrotic areas, and a clear distinction from the adjacent structures. The patient underwent a right adrenalectomy. The histological examination of the tumor revealed a borderline adrenocortical oncocytoma. The patient had an uncomplicated postoperative course and was discharged on postoperative day 8. Similar cases reported in the literature are also being reviewed in this case report.
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Affiliation(s)
- Efstathios Kotidis
- Fourth Academic Department of Surgery, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Bitsianis
- Fourth Academic Department of Surgery, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Galanos-Demiris
- Fourth Academic Department of Surgery, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Christidis
- Fourth Academic Department of Surgery, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Mantzoros
- Fourth Academic Department of Surgery, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Orestis Ioannidis
- Fourth Academic Department of Surgery, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilis Foutsitzis
- Fourth Academic Department of Surgery, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Manousos George Pramateftakis
- Fourth Academic Department of Surgery, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stamatios Aggelopoulos
- Fourth Academic Department of Surgery, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
Ectopia of nodular adrenocortical tissue is very frequently found in the periadrenal region. It corresponds to accessory adrenal tissue and is a normal variant. Ectopia in more distant regions are found in inner male or female genitalia. Strong long-lasting hyperstimultions induce hyperplasia and simulate true tumors ("adrenal rest tumors"). Real autonomic tumors from ectopic adrenal tissue with or without hyperfunction are rare. Ectopia of adrenomedullary tissue are nearly exclusively found in the surroundings of normal medulla. Ectopia in the adrenals corresponds almost exclusively with thyroid tissue. Ectopic secretion of hormones, mostly ACTH, can be found in pheochromocytomas and induces hyperfunction (Cushing's syndrome).
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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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Adrenal Rest Tumor of the Liver Preoperatively Diagnosed as Hepatocellular Carcinoma. Case Rep Surg 2017; 2017:8231943. [PMID: 28706747 PMCID: PMC5494576 DOI: 10.1155/2017/8231943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/28/2017] [Indexed: 11/30/2022] Open
Abstract
Background Hepatic adrenal rest tumors are rare and show similar findings to hepatocellular carcinoma (HCC). It is difficult to distinguish an adrenal rest tumor from HCC due to radiological similarity. We report a case of an adrenal rest tumor in the liver that mimicked HCC radiologically. Case Presentation A 67-year-old female was referred to our hospital due to the finding of a hepatic mass. Enhanced computed tomography revealed a 17 mm well-defined tumor that was enhanced in the arterial phase and washed out in the portal and delayed phase in the posterosuperior subsegment of the right hepatic lobe, and HCC was suspected. We performed a subsegmental resection of the liver. Microscopic findings showed that the tumor was composed of pale cells, and tumor cells were aligned in alveolar or fascicular arrangements in a similar manner to features of adrenocortical tissue. Immunohistochemically, the tumor expressed synaptophysin and CD56. The final histopathologic diagnosis in this case was an adrenal rest tumor of the liver. Conclusions An adrenal rest tumor is similar to HCC in radiological findings. This hepatic tumor should be added to the list of radiological differential diagnoses of hypervascular hepatic tumors.
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Adrenal Collision Tumor: Coexistence of Pigmented Adrenal Cortical Oncocytoma and Ganglioneuroma. Case Rep Surg 2017; 2016:5790645. [PMID: 28053800 PMCID: PMC5178330 DOI: 10.1155/2016/5790645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/13/2016] [Accepted: 11/08/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Adrenal collision tumors (ACTs), in which distinct tumors coexist without intermingling in the same adrenal gland, are rare and their actual prevalence is unknown. ACTs commonly consist of adrenal cortical adenoma, pheochromocytoma, or metastatic malignant tumor. Case Report. A 32-year-old woman who had been experiencing gastric discomfort for one month was referred to our hospital with abnormal imaging findings. The physical examination and the laboratory data including endocrine studies were unremarkable. Abdomen computed tomography (CT) and magnetic resonance imaging (MRI) showed two adjacent masses in the left suprarenal fossa, and a laparoscopic left adrenalectomy was done. Histological and immunohistochemical (IHC) examinations revealed two distinct tumors: a pigmented adrenal cortical oncocytoma (ACO) and a ganglioneuroma, respectively. Conclusion. Both tumors are rare in the adrenal gland and exist as ACTs only exceptionally rarely. This is the first reported case of coexisting oncocytoma and ganglioneuroma in the same adrenal gland to our knowledge.
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Khandakar B, Dey S, Ray PS, Sarkar R, Bhattacharyya P. Ectopic Paratubal Adrenal Cell Rest Associated with Mucinous Cystadenoma of Ovary. J Clin Diagn Res 2015; 9:ED13-4. [PMID: 26557532 DOI: 10.7860/jcdr/2015/15411.6638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 08/24/2015] [Indexed: 11/24/2022]
Abstract
Ectopic adrenal cortex is a rare entity. Usually found in male children; commonly located around kidney, retroperitoneum, spermatic cord and para-testicular region. Rarely, adults with heterotopic adrenal glands are described. Incidence in females is very less; though sometimes detected accidentally in hysterectomy specimens. We describe a case of ectopic adrenal cortical cell in paratubal region in a patient with mucinous cyst adenoma of ovary. A 26-year-old female presented with complains of menstrual irregularities and abdominal discomfort for 6 months. Investigations suggested a right ovarian cyst. Right ovarian cystectomy with partial salpingectomy was performed; histopathology revealed mucinous cyst adenoma. Sections from tube showed presence of ectopic adrenal cortical rest in the paratubal region, incidentally discovered on microscopy. We present this case because of its rarity in females, interesting presentation with another unrelated gynaecological pathology, its potentiality for malignant transformation and possible complications.
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Affiliation(s)
- Binny Khandakar
- Demonstrator, Department of Pathology, Nil Ratan Sircar Medical College & Hospital , Kolkata, India
| | - Soumit Dey
- Demonstrator, Department of Pathology, Nil Ratan Sircar Medical College & Hospital , Kolkata, India
| | - Prasenjit Sen Ray
- Demonstrator, Department of Pathology, Nil Ratan Sircar Medical College & Hospital , Kolkata, India
| | - Ranu Sarkar
- Professor, Department of Pathology, Nil Ratan Sircar Medical College & Hospital , Kolkata, India
| | - Palas Bhattacharyya
- Associate Professor, Department of Pathology, Nil Ratan Sircar Medical College & Hospital , Kolkata, India
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Godin K, Bang N, Tolkach Y. Case report: Heterotopic intrarenally located adrenocortical oncocytoma. F1000Res 2014; 3:73. [PMID: 25254096 PMCID: PMC4168838 DOI: 10.12688/f1000research.3780.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/20/2022] Open
Abstract
The clinical case of a 65-year-old woman with an incidentally detected left-sided mass in the upper renal pole is presented. A functional adrenal tumor was excluded. The mass was removed retroperitoneoscopically. The perioperative period was uneventful. The histopathological examination revealed a heterotopic intrarenal adrenocortical oncocytoma. Adrenal oncocytic neoplasms are very rare, with, to the authors’ knowledge, only 159 described cases so far. Most cases are non-functioning adenomas that can reach a considerable size. Only 10 heterotopic adrenal oncocytomas have been described (three retroperitoneal and seven intraspinal cases). Although the intrarenal adrenal rest is the most frequently appearing variant of adrenal heterotopia, to the best of our knowledge, this report is the first description of an intrarenally growing adrenocortical oncocytic adenoma. In addition to retroperitoneally located oncocytomas, this case could be interesting for urological practice because there are no diagnostic features which could provide a secure preoperative diagnosis of an adrenal oncocytic neoplasm and its malignant variant. Generally accepted indications for surgery of adrenal masses have to be respected. The definitive pathologic diagnosis is in most cases surprising because of its rarity. Benign adrenal oncocytic neoplasms do not require any adjuvant treatment. The oncocytic variant of adrenocortical carcinoma generally has a poor prognosis.
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Affiliation(s)
- Konstantin Godin
- Südharz Klinikum Nordhausen gGmbH, Urology Clinic, Nordhausen, 99734, Germany
| | - Nicole Bang
- Südharz Klinikum Nordhausen gGmbH, Pathology Clinic, Nordhausen, 99734, Germany
| | - Yuri Tolkach
- Medizinische Hochschule Hannover, Urology and Urologic Oncology Clinic, Hannover, 30625, Germany
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