Oncocytic Adrenocortical Neoplasm with Concomitant Papillary Thyroid Cancer

Laparoscopic resection of an adrenal oncocytic neoplasm: Report of a case and review of the literature

•

Oncocytic adrenal neoplasms are rare and mostly benign lesions.

•

Preoperative determination of malignancy remains difficult.

•

Surgical excision planification is based on preoperative investigations.

Introduction

Oncocytic adrenal neoplasms are rare and mostly benign lesions. Available literature supports indication for a surgical resection, but criteria to predict aggressive behavior are unreliable, thus making decision of surgical approach (laparotomy versus laparoscopy), and extent of resection, difficult to define.

Presentation of case

This is the case of a 46-year-old male, with an incidental finding of a 10 cm asymptomatic tumor in the left adrenal gland identified by MRI, performed in the setting of the initial assessment of liver steatosis. Adrenal hormone levels were in the normal range, thus, a CT-guided needle biopsy was performed and showed an adrenocortical oncocytic neoplasm. A laparoscopic left adrenalectomy was performed sparing the adjacent left kidney. Histological examination of the resected tumor showed a 10 cm oncocytic adrenocortical neoplasm of uncertain malignant potential with negative resection margins. A follow-up MRI was scheduled at six months after surgery, and no recurrence was found.

Conclusions

Although rare, oncocytic neoplasms should be included in the differential diagnosis of adrenal “incidentalomas”. Determination of their malignant potential is difficult in the preoperatory setting. Final diagnosis is based on histological analysis of the whole surgical specimen. Laparoscopic complete excision with negative resection margins is feasible and safe.

A Rare Concomitant Oncocytic Adrenocortical Neoplasm and Hepatocellular Carcinoma over a Four-year Duration: A Case Report and Review of Literature

Oncocytic adrenocortical neoplasms (OANs) are very rare. Although most cases have benign behavior, the risk of recurrence/metastasis is variable. Based on Lin-Weiss-Bisceglia (LWB) system criteria, OANs can be classified as benign, borderline, or malignant. A concomitant development of OANs with second primary neoplasm is extremely uncommon, and is limited to very few case reports. None of these reported cases was found to be associated with hepatocellular carcinoma (HCC). In this case report, we present a 64-year-old female patient who had a progressively increasing left supra-renal mass over a three-year interval. During her regular imaging-based follow up after successful left adrenalectomy, a new suspicious solitary, hypodense liver mass was detected and removed. All necessary work-up was done and strongly support the diagnosis of two distinct primary tumors including borderline malignant potential OAN and subsequent HCC. A significant clinical and morphological characteristic of OANs make its identification valuable.

A rare combination of giant right retroperitoneal schwannoma and right adrenal oncocytoma as an incidental finding

Adrenal oncocytomas and retroperitoneal schwannomas are two groups of very rare tumors with distinct histologic features. Both tumors are usually incidentally found and are mostly benign. Optimal management is usually with surgical resection. We report a unique case of a 74-year-old woman who was incidentally found to have these two exceptionally rare tumors at the same time. She was successfully managed with surgical resection of the retroperitoneal schwannoma and adrenalectomy for the adrenal oncocytoma and both diagnoses were confirmed with histopathology and immunochemistry.