April - June 2012, Volume 8, Issue 2

Erem C, Ucuncu O, Nuhoglu I, Turkyilmaz S, Yildiz K, Civan N, Akcay M

Large Adrenocortical Oncocytoma with Uncertain Malignant Potential: Report of a New Case and Review of the Literature

Acta Endo (Buc) 2012, 8 (2): 295-306
doi: 10.4183/aeb.2012.295

Background. Adrenocortical oncocytoma (ACO) is exceedingly rare. To date, only 81 cases are reported in the English literature. Most of ACOs are nonfunctioning and benign.\r\nCase report. We describe a case of ACO incidentally diagnosed in a 54-yearold male patient. Physical examination, routine laboratory studies and hormonal tests were within normal ranges. Abdominal computed tomography (CT) and magnetic resonance imaging showed a large and\r\nheterogeneous tumor (9x7x6 cm) in the left adrenal gland with borderline malignant characteristics. Left adrenalectomy was performed for treatment purposes. The cut\r\nsurface of the resected tumor was heterogeneous with tan brown color with areas of extensive hemorrhage and necrosis.\r\nMicroscopically, the tumor consisted predominantly of large polygonal cells containing eosinophilic granular cytoplasm\r\narranged in a solid pattern with abundant hemorrhage and necrosis. The tumor showed a compressed remnant of adrenal\r\ncortex in the outer the capsule of the mass. No vascular and capsular invasion was noted, and mitotic figures were not\r\nconspicuous. Immunohistochemically, the tumor cells were diffusely and strongly positive for melan-A, vimentin, alphainhibin, weakly positive for synaptophysin and calretinin. The tumor was focal and erratively positive for pancytokeratin. No immunoreactivity was observed form\r\nchromogranin-A, CD10 or p53. The histological diagnosis was ACO with uncertain malignant potential.\r\nConclusions. ACO occurs rarely in adults and preoperative diagnosis is difficult, especially in asymptomatic cases.\r\nIt needs careful evaluation and surgical treatment. According to our knowledge, this is the 2th case of ACO in an adult patient from Turkey in English literature. We\r\ndiscuss this case and review the literature on this unusual entity.

Keywords: Adrenocortical tumor, oncocytoma, immunohistochemistry

Correspondence: C. Erem, K.T.?. Tip Fak?ltesi, I? Hastaliklari Anabilim Dali, 61080, Trabzon, Turkey, Fax no: + 90 462-325 22 70, Phone: +90 462 3775449, E-Mail: cihangirerem@hotmail.com, cihangirerem@meds.ktu.edu.tr