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Qi HF, Chen LQ, Yang MQ, Li XF, Zhang HN, Zhang KX, Xu HT. Primary adenomatoid tumor of the adrenal gland: A case report and literature review. Medicine (Baltimore) 2023; 102:e36739. [PMID: 38115250 PMCID: PMC10727588 DOI: 10.1097/md.0000000000036739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023] Open
Abstract
RATIONALE Adenomatoid tumors are rare benign tumors, mainly involving the reproductive tract, such as the epididymis in men and the uterus and fallopian tubes in women. However, a few cases can occur outside the reproductive tract. Herein, we report a rare case of a primary adenomatoid tumor of the adrenal gland. PATIENT CONCERNS A 50-year-old man underwent ultrasound examination and was found to have a right adrenal mass without elevated blood pressure, weakness after fatigue, frequent nocturnal urination urgency, pain, or a history of hematuria. The patient's general health was normal. Computed tomography revealed a polycystic mixed-density lesion in the right adrenal region, approximately 7.3 × 4.5 cm in size. DIAGNOSES Based on the clinical information, morphological features, and immunohistochemistry results, a pathological diagnosis of primary adenomatoid tumor of the adrenal gland was made. INTERVENTION Excision of the right adrenal gland and tumor through the 11 ribs. OUTCOMES The patient's postoperative course was uneventful. LESSONS Preventing misdiagnosis adenomatoid tumors with other types of adrenal gland tumors or metastatic tumors is imperative. Morphological and immunohistochemical features can help diagnose primary adenomatoid tumors of the adrenal gland.
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Affiliation(s)
- Hong-Feng Qi
- Department of Thoracic and Cardiac Surgery, Changyi People’s Hospital, Changyi, China
| | - Li-Qian Chen
- Department of Pathology, Weifang People’s Hospital (First Affiliated Hospital of Weifang Medical University), Weifang, China
| | - Mai-Qing Yang
- Department of Pathology, Weifang People’s Hospital (First Affiliated Hospital of Weifang Medical University), Weifang, China
| | - Xiu-Feng Li
- Department of Pathology, Weifang People’s Hospital (First Affiliated Hospital of Weifang Medical University), Weifang, China
| | - Hai-Ning Zhang
- Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Ke-Xin Zhang
- Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Hong-Tao Xu
- Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
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Guan J, Zhao C, Li H, Zhang W, Lin W, Tang L, Chen J. Adenomatoid Tumor of the Adrenal Gland: Report of Two Cases and Review of the Literature. Front Endocrinol (Lausanne) 2021; 12:692553. [PMID: 34248850 PMCID: PMC8261242 DOI: 10.3389/fendo.2021.692553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Adenomatoid tumor (AT) is an uncommon benign neoplasm of mesothelial origin, usually occurring in the female and male genital tracts. Extragenital localization such as the adrenal gland is extremely rare. Until now, only 39 cases of adrenal AT have been reported in the English literature. Here we report two novel cases of adrenal AT that occurred in male patients aged 30 and 31 years. The tumors were discovered incidentally by computed tomography (CT). Macroscopically, the tumors were unilateral and solid, and the greatest dimension of the tumors was 3.5 and 8.0 cm, respectively. Histologically, the tumors consisted of angiomatoid, cystic, and solid patterns and infiltrated the adrenal cortical or medullary tissue. The tumor cells had low nuclear/cytoplasmic ratio, with no pathological mitosis or nuclear pleomorphism. Thread-like bridging strands and signet-ring-like cells could be seen. Immunohistochemically, the tumor cells were positive for epithelial markers (AE1/AE3, CK7) and mesothelial markers (D2-40, calretinin, and WT-1). The Ki-67 index was approximately 1 and 2%, respectively. The differential diagnosis of adrenal AT includes a variety of benign and malignant tumors. The patients had neither local recurrence nor distant metastasis at 21 and 8 months after removal of the tumor. In the literature review, we comprehensively summarized the clinical, morphological, immunohistochemical, and prognostic features of adrenal AT. Adrenal ATs are morphologically and immunophenotypically identical to those that occur in the genital tracts. Combining the histology with immunohistochemical profiles is very supportive in reaching the diagnosis of this benign tumor, helping to avoid misdiagnosis and overtreatment.
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Affiliation(s)
- Jiexia Guan
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chang Zhao
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hengming Li
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Wenjing Zhang
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Weizhen Lin
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Luying Tang
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianning Chen
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Jianning Chen,
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Ferreira I, De Lathouwer O, Fierens H, Theunis A, André J, de Saint Aubain N. Adenomatoid tumor of the skin: Differential diagnosis of an umbilical erythematous plaque. J Cutan Pathol 2020; 48:128-132. [PMID: 32918316 DOI: 10.1111/cup.13872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 11/26/2022]
Abstract
Adenomatoid tumors are benign tumors of mesothelial origin that are usually encountered in the genital tract. Although they have been observed in other organs, the skin appears to be a very rare location, with only one case reported in the literature to our knowledge. We report a second case of an adenomatoid tumor, arising in the umbilicus of a 44-year-old woman. The patient presented with an 8-month-old erythematous and firm plaque under the umbilicus. A skin biopsy showed numerous microcystic spaces dissecting a fibrous stroma and lined by flattened to cuboidal cells with focal intraluminal papillary formation. This little-known diagnosis constitutes a diagnostic pitfall for dermatopathologists and dermatologists, and could be misdiagnosed as other benign or malignant entities. Through this case report, a practical approach and diagnostic keys have been devised to avoid misdiagnosis and overtreatment.
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Affiliation(s)
- Ingrid Ferreira
- Dermatopathology laboratory, Department of Dermatology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier De Lathouwer
- Department of Plastic Surgery, Centre Hospitalier Interrégional Edith Cavell, Brussels, Belgium
| | - Hugues Fierens
- Department of Dermatology, Saint-Jean Hospital, Brussels, Belgium
| | - Anne Theunis
- Dermatopathology laboratory, Department of Dermatology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Josette André
- Dermatopathology laboratory, Department of Dermatology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas de Saint Aubain
- Department of Pathology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
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Abstract
A 28-year old man, with previous history of chronic abdominal pain, was referred to our nuclear medicine center for an F-FDG PET/CT following the fortuitous discovery of a 48-mm right adrenal gland lesion of heterogeneous density at the CT scan. The PET/CT showed an isolated heterogeneous significant uptake evocative of neoplasia. Surprisingly, the anatomopathological analysis after surgery revealed an adenoid tumor of the adrenal gland. This case of a rare benign tumor can be a source of false-positive and mimicking malignancies in the exploration of adrenal lesions.
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Abstract
The fourth edition of the World Health Organization (WHO) classification of endocrine tumours contains substantial new findings for the adrenal tumours. The tumours are presented in two chapters labelled as "Tumours of the adrenal cortex" and "Tumours of the adrenal medulla and extra-adrenal paraganglia." Tumours of the adrenal cortex are classified as cortical carcinoma, cortical adenoma, sex cord stromal tumours, adenomatoid tumour, mesenchymal and stromal tumours (myelolipoma and schwannoma), haematological tumours, and secondary tumours. Amongst them, schwannoma and haematological tumours are newly documented. The major updates in adrenal cortical lesions are noted in the genetics of the cortical carcinoma and cortical adenoma based on the data from The Cancer Genome Atlas (TCGA). Also, a system for differentiation of oncocytoma from oncocytic cortical carcinoma is adopted. Tumours of the adrenal medulla and extra-adrenal paraganglia comprise pheochromocytoma, paraganglioma (head and neck paraganglioma and sympathetic paraganglioma), neuroblastic tumours (neuroblastoma, nodular ganglioneuroblastoma, intermixed ganglioneuroblastoma, and ganglioneuroma), composite pheochromocytoma, and composite paraganglioma. In this group, neuroblastic tumours are newly included in the classification. The clinical features, histology, associated pathologies, genetics, and predictive factors of pheochromocytoma and paraganglioma are the main changes introduced in this chapter of WHO classification of endocrine tumours. The term "metastatic pheochromocytoma/paraganglioma" is used to replace "malignant pheochromocytoma/paraganglioma." Also, composite pheochromocytoma and composite paraganglioma are now documented in separate sections instead of one. Overall, the new classification incorporated new data on pathology, clinical behaviour, and genetics of the adrenal tumours that are important for current management of patients with these tumours.
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Affiliation(s)
- Alfred King-Yin Lam
- Cancer Molecular Pathology, School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Q4222, Australia.
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Taskin OC, Gucer H, Mete O. An Unusual Adrenal Cortical Nodule: Composite Adrenal Cortical Adenoma and Adenomatoid Tumor. Endocr Pathol 2015; 26:370-3. [PMID: 25861051 DOI: 10.1007/s12022-015-9365-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Orhun Cig Taskin
- Department of Pathology, University Health Network, 200 Elizabeth Street, 11th floor, Toronto, Ontario, M5G 2C4, Canada
| | - Hasan Gucer
- Department of Pathology, University Health Network, 200 Elizabeth Street, 11th floor, Toronto, Ontario, M5G 2C4, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Ozgur Mete
- Department of Pathology, University Health Network, 200 Elizabeth Street, 11th floor, Toronto, Ontario, M5G 2C4, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
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Sağlıcan Y, Kurtulmus N, Tunca F, Süleyman E. Mesothelial derived adenomatoid tumour in a location devoid of mesothelium: adrenal adenomatoid tumour. BMJ Case Rep 2015; 2015:bcr-2015-211147. [PMID: 26243749 DOI: 10.1136/bcr-2015-211147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This is a case report of a 40-year-old man with an adrenal mass that was found incidentally on routine check-up examination. MRI showed a 30 × 51 × 57 mm cystic-semisolid heterogeneous mass; hormonal functions were within normal limits. Operative removal was planned because of the large size of the mass. Histopathological and immunohistochemical findings were consistent with adenomatoid tumour. The patient was disease-free at 1 year follow-up. We present this case with its radiological and histological characteristics under the review of the literature.
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Affiliation(s)
- Yeşim Sağlıcan
- Department of Pathology, Acibadem University, Istanbul, Turkey
| | - Neslihan Kurtulmus
- Department of Endocrinology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Fatih Tunca
- Department of Surgery, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Erdoğan Süleyman
- Department of Radiology, Acibadem Maslak Hospital, Istanbul, Turkey
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Babinska A, Peksa R, Swiątkowska-Stodulska R, Sworczak K. The collection of five interesting cases of adrenal tumors from one medical center. World J Surg Oncol 2014; 12:377. [PMID: 25487416 PMCID: PMC4295261 DOI: 10.1186/1477-7819-12-377] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 11/13/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Adrenal tumors are detected incidentally in 4 to 8% of patients in imaging studies. Adenomas, pheochromocytomas and adrenocortical carcinomas represent the most common tumors of the adrenal glands. Rarely are final histopathological reports are surprising. AIM The aim of our study is a retrospective analysis of selected clinical characteristics and hormonal studies in five cases of rare adrenal tumors. MATERIALS AND METHODS We present five interesting cases of adrenal tumors: two medullary hyperplasia, one adenomatoid tumor, one hydatid cyst and a primary angiosarcoma of the adrenal gland. The final diagnosis was established by means of microscopic examination of the specimens. CONCLUSIONS The number of adrenal tumors was increased due to widespread use of imaging procedures. In patients without any known extra-adrenal malignancy most lesions are benign, non-hyper functioning adenomas. Adrenal tumors should be evaluated biochemically and radiologically.
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Affiliation(s)
- Anna Babinska
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Dębinki St 80-288, Poland.
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Zhao M, Li C, Zheng J, Yan M, Sun K, Wang Z. Cystic lymphangioma-like adenomatoid tumor of the adrenal gland: report of a rare case and review of the literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 6:943-950. [PMID: 23638228 PMCID: PMC3638107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 03/19/2013] [Indexed: 06/02/2023]
Abstract
Adenomatoid tumors (AT) are uncommon, benign tumors of mesothelial origination most frequently encountered in the genital tracts of both sexes. Their occurrences in the extragenital sites are much rarer and could elicit a variety of differential diagnosis both clinically and morphologically. With regard to the adrenal gland, to the best knowledge of us, only 31 cases of AT have been reported in the English literature. Several histologic growth patterns have been documented in AT, among which cystic type is the least common one. We herein present a further case of AT arising in the adrenal of a 62-year-old Chinese man with a medical history for systemic hypertensive disease. The tumor was incidentally identified during routine medical examination. An abdomen computed tomography scan revealed a solitary mass in the right adrenal. Grossly, the poorly-circumscribed mass measured 3.0 x 3.0 x 2.0 cm with a cut surface showing a gelatinous texture with numerous tiny cystic structures. Microscopic examination showed an infiltrated lesion with honeycomb appearance mimicking a lymphangioma, which composed predominantly of variably sized and shaped anastomosing small cystic spaces lined by flattened endothelial-like cells, without any epithelioid or signet-ring like components present. Foci of extraadrenal tumor extension, lymphoid aggregates with occasional germinal centre formation, intralesional fat tissue, stromal myoid proliferation and ossification were also observed. Immunohistochemical analyses confirmed the mesothelial differentiation of this tumor and indicated a diagnosis of cystic lymphangiomatoid AT of the adrenal.
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Affiliation(s)
- Ming Zhao
- Department of Pathology, Ningbo Yinzhou Second Hospital, Ningbo, Zhejiang Province, PR China.
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