Adrenal adenomatoid tumor in a patient with human immunodeficiency virus

Primary adenomatoid tumor of the adrenal gland: A case report and literature review

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.

Adenomatoid Tumor of the Adrenal Gland: Report of Two Cases and Review of the Literature

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.

Adenomatoid Tumor: A Review of Pathology With Focus on Unusual Presentations and Sites, Histogenesis, Differential Diagnosis, and Molecular and Clinical Aspects With a Historic Overview of Its Description

Adenomatoid tumors have been described almost a century ago, and their nature has been the subject of debate for decades. They are tumors of mesothelial origin usually involving the uterus, the Fallopian tubes, and the paratesticular region. Adenomatoid tumors of the adrenal gland, the liver, the extragenital peritoneum, the pleura, and the mediastinum have been rarely reported. They are usually small incidental findings, but large, multicystic and papillary tumors, as well as multiple tumors have been described. Their pathogenesis is related to immunosuppression and to TRAF7 mutations. Despite being benign tumors, there are several macroscopic or clinical aspects that could raise diagnostic difficulties. The aim of this review was to describe the microscopic and macroscopic aspects of adenomatoid tumor with a special focus on its differential diagnosis and pathogenesis and the possible link of adenomatoid tumor with other mesothelial lesions, such as the well-differentiated papillary mesothelioma and the benign multicystic mesothelioma, also known as multilocular peritoneal cysts.

Adenomatoid tumor of the skin: Differential diagnosis of an umbilical erythematous plaque

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.

Renal transplantation-related risk factors for the development of uterine adenomatoid tumors

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We analyzed the epidemiological factors for clinical manifestations of uterine adenomatoid tumors.

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Renal transplantation with immunosuppression therapy is risk factor for the development of uterine adenomatoid tumors.

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The length of time on dialysis is risk factor for the development of uterine adenomatoid tumors.

[A CASE OF ADRENAL ADENOMATOID TUMOR DIAGNOSED BY IMMUNOHISTOCHEMICAL EVALUATION]

An adenomatoid tumor is a benign tumor of mesothelial derivation, typically found in the genital track. However, though extremely rare, an adenomatoid tumor can be found in the adrenal gland, making it difficult to clinically and radiologically differentiate it from an adrenocortical tumor or a pheochromocytoma prior to surgery. We encountered a-52-year old man with an adenomatoid tumor in the adrenal gland, who presented with an incidentally discovered left adrenal mass revealed by PET-CT from his regular health examinations. He had been diagnosed with paroxysmal hypertension two years before and was being treated with a hypolipidemic agent. Abdominal computed tomography revealed a left adrenal mass measuring 25 × 15 mm, and the findings were different from the typical adrenocortical adenoma or pheochromocytoma. Although laboratory examinations of his blood samples indicated normal adrenal function, 24-hour urine specimens revealed high levels of 17-OHCS, 17-KS, and catecholamine. Both ¹³¹I-MIBG scintigraphy and phentolamine tests showed negative findings. The patient underwent a laparoscopic left adrenalectomy. The cut surface of the left adrenal gland weighing 21 g contained a white, solid mass measuring 25 × 15 × 20 mm within the adrenocortical tissue. Histologically, the tumor was composed of small tubules lined by eosinophilic tumor cells. The tumor cells were immunohistochemically positive for cytokeratins and calretinin, but negative for steroidogenic factor-1. Therefore, based on these findings, we diagnosed this tumor as an adrenal adenomatoid tumor. Histopathologically, the adrenal adenomatoid tumor may be difficult to distinguish from an adrenocortical adenoma, carcinoma, lymphangioma, hemangioma, angiosarcoma, or metastatic adenocarcinoma. Under these conditions, immunohistochemical examination is useful for definite diagnosis.

Mesothelial derived adenomatoid tumour in a location devoid of mesothelium: adrenal adenomatoid tumour

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.

Cystic lymphangioma-like adenomatoid tumor of the adrenal gland: report of a rare case and review of the literature

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.