Endocrine Abstracts

Introduction: Myxoid adrenocortical adenoma was described by Brown et al. in 2000 (1). Myxoid adrenal cortical adenoma with pseudo glandular structure is a particular histological variant and is extremely rare. Accurate diagnosis is based on the combined evaluation of clinical features, adrenal imaging, and pathological features. Immunohistochemical studies (cytokeratin, melan-A, USP10, chromogranin, vimentin) can distinguish adrenocortical adenoma from other retroperitoneal myxoid tumors (2).

Case: A 43-year-old male patient uses a bi-level positive airway pressure device for known obstructive sleep apnea syndrome. The patient described occasional high blood pressure had left flank pain in the last 15 days. No pathology was detected in the urinalysis performed by the urology and in the abdominal X-ray. Contrast-enhanced upper abdomen computed tomography was then performed on the patient. In his report, it was seen that there was a 29×27 mm mass lesion in the left adrenal gland with intense contrast enhancement in the arterial and venous phases. In the 1 mg dexamethasone suppression test performed by us, aldosterone, renin, adrenaline, noradrenaline, dopamine, metanephrine and normetanephrine levels were within the normal range. Doxazosin treatment was given to the patient who described occasional blood pressure attacks. The patient underwent laparoscopic left adrenalectomy two weeks later. No complications developed. Histopathological study showed that the mass was a myxoid adrenocortical adenoma with a pseudo glandular pattern. Immunohistochemically, vimentin, CD56, melan-A, CK8 were diffusely positive, while inhibin was focally positive. No immunoreactivity was found in cytokeratin 7, S-100, calretinin, synaptophysin, chromogranin A, TTF1, CK7, napsin, mesolthelin, WT-1, PanCK, CD99. The patient has been followed for 15 months after laparoscopic adrenalectomy. No pathology was detected in the control adrenal hormone profile and control computed tomography. Blood pressure is regulated.

Conclusion: Myxoid adrenocortical adenoma with pseudo glandular pattern may suggest adrenocortical metastasis or pheochromistoma by adrenal imaging method. Immunohistochemical markers are very useful in differential diagnosis.

References: 1-Brown FM, Gaffey TA, Wold LE, Lloyd RV. Myxoid neoplasms of the adrenal cortex: a rare histologic variant. Am J Surg Pathol. 2000;24:396–401.

2-Zeng Z, Gu LJ, Zhou ZY, Liu L, Yan HL, Huang YB, Wang ZS, Chen J, Yuan JP. Myxoid adrenocortical adenoma with a pseudo glandular pattern: a case report and literature review Int J Clin Exp Pathol 2017;10(8):8908–8915.