Journal of Pathology and Translational Medicine

Case Study

An Intrarenal Adrenocortical Carcinoma Arising in an Adrenal Rest: Ji Hee Lee, Young Deuk Choi, Nam Hoon Cho; J Pathol Transl Med. 2018;52(6):416-419. Published online October 1, 2018; DOI: https://doi.org/10.4132/jptm.2018.07.20

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We describe a case of a 61-year-old Korean man who was diagnosed with renal cell carcinoma that was discovered on abdominopelvic computed tomography obtained after the patient complained of back pain. A radical nephrectomy was performed, and the surgical specimen showed a relatively well-circumscribed and yellowish lobulated hard mass. Microscopically, the tumor showed sheets and nests of hypercellular pleomorphic cells with thick fibrous septation, frequent mitoses, and areas of adrenal cortical-like tissue. Immunohistochemical staining revealed that the tumor cells were positive for inhibin-α, vimentin, synaptophysin, and melan A. It also revealed that the tumor cells were negative for pan-cytokeratin, epithelial membrane antigen, paired box 8, α-methylacyl-coenzyme A racemase, CD10, cytokeratin 7, carbonic anhydrase 9, c-Kit, renal cell carcinoma, transcription factor E3, human melanoma black 45, desmin, smooth muscle actin, S-100, chromogranin A, CD34, anaplastic lymphoma kinase, and integrase interactor 1. Based on these histopathological and immunohistochemical findings, we diagnosed the tumor as intrarenal adrenocortical carcinoma arising in an adrenal rest. Several cases of intrarenal adrenocortical carcinoma have been reported, although they are very rare. Due to its poor prognosis and common recurrence or metastasis, clinicians and pathologists must be aware of this entity.

Citations

Citations to this article as recorded by

Ectopic adrenal tissue in the kidney: A systematic review
Davide De Marchi, Alessandro Tafuri, Guglielmo Mantica, Aliasger Shakir, Federico Scarfò, Giovanni Passaretti, Salvatore Smelzo, Silvia Proietti, Lorenzo Rigatti, Roberta Luciano, Alessandro Antonelli, Vincenzo Pagliarulo, Rosario Leonardi, Gu
Archivio Italiano di Urologia e Andrologia.2021; 93(4): 481. CrossRef
Extra-adrenal, non-functional adrenocortical carcinoma presenting with acute abdomen: a case report
Alireza Mirsharifi, Mohammad Vasei, Ehsan Sadeghian, Ali Ghorbani-Abdehgah, Sara Naybandi Atashi
Journal of Medical Case Reports.2020;[Epub] CrossRef
Testicular Adrenal Rest Tumors: Current Insights on Prevalence, Characteristics, Origin, and Treatment
Manon Engels, Paul N Span, Antonius E van Herwaarden, Fred C G J Sweep, Nike M M L Stikkelbroeck, Hedi L Claahsen-van der Grinten
Endocrine Reviews.2019; 40(4): 973. CrossRef

Case Reports

The Fine Needle Aspiration Cytology of a Metastatic Pulmonary Adrenocortical Carcinoma Mimicking Primary Large Cell Carcinoma of the Lung.: Na Rae Kim, Dong Hae Chung, Jae Ik Lee, Seung Yeon Ha; Korean J Pathol. 2010;44(5):558-563.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.5.558

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Abstract PDF: Adrenocortical carcinoma is a rare neoplasm and it has an invariably lethal prognosis. We report here on the fine needle aspiration cytologic findings of a solitary metastatic pulmonary adrenocortical carcinoma in a 24-year-old woman. The aspirate smears were very cellular and they were composed of a monomorphic population of large polyhedral cells with abundant granular or vacuolated cytoplasm, and the cells were predominantly singly scattered in a necrotic background. Multinucleated pleomorphic tumor cells were also found. Pleomorphic nuclei with thickened nuclear membranes were impinging on the cell membranes. Mitotic activity was occasionally seen. The cytologic findings of pleomorphic cells with microvacuolated cytoplasm and the presence of vague gland-like sheets, as well as the patient's history of undergoing adrenalectomy for primary adrenocortical carcinoma helped the pathologist reach the diagnosis of metastatic adrenocortical carcinoma. Here, we focus on the cytologic differential points of metastastic pulmonary adrenocortical carcinoma and primary pulmonary carcinoma, especially large cell carcinoma.

Adrenocortical Carcinoma, Myxoid Variant: A Case Report.: Bomi Kim, Sun Och Yoon, Dong Il Kim, Myung Cherl Kook, Eun Kyung Hong; Korean J Pathol. 2007;41(6):430-435.

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Abstract PDF: Myxoid variant of adrenal cortical carcinoma is extremely rare and there have been only 16 such cases reported in the medical literature. Here we report on a case of 43-year-old woman with a left adrenal mass that was detected during the evaluation for Cushing's syndrome. Left adrenalectomy was performed and the tumor weighed 347 g. The cut surface was predominantly myxoid and gelatinous with central hemorrhage and necrosis. Histologically, the tumor cells were rather small, uniform and polygonal with mild pleomorphism. It showed diverse morphologic patterns according to the amount of the myxoid stromal component. Making the diagnosis was not easy because the tumor was without areas of conventional adrenocortical carcinoma. Immunohistochemically, the tumor cells were positive for alpha-inhibin, synaptophysin and vimentin, but the tumor cells were negative for pan-cytokeratin and CAM 5.2. The immunophenotypes were identical to those of conventional adrenal cortical neoplasms. During the evaluation of a cytokeratin-negative and vimentin-positive retroperitoneal neoplasm with a myxoid component, the possibility of adrenal cortical tumor should be considered in spite that this is a very rare entity.

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