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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 2  |  Page : 237-239
Functioning adrenocortical oncocytoma: A case report and review of literature


Transplant Research Center, Department of Pathology, Shiraz University of Medical Science, Shiraz, PO Box: 71345-1864, Iran

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   Abstract 

Adrenocortical oncocytoma is very rare. Less than five functioning types of them are reported and most of the reported cases are incidentally found. We herein report a case of functioning adrenocortical oncocytoma of the left adrenal cortex in a young woman.

Keywords: Adrenal, benign, functioning, oncocytoma, tumor

How to cite this article:
Geramizadeh B, Norouzzadeh B, Bolandparvaz S, Sefidbakht S. Functioning adrenocortical oncocytoma: A case report and review of literature. Indian J Pathol Microbiol 2008;51:237-9

How to cite this URL:
Geramizadeh B, Norouzzadeh B, Bolandparvaz S, Sefidbakht S. Functioning adrenocortical oncocytoma: A case report and review of literature. Indian J Pathol Microbiol [serial online] 2008 [cited 2019 Oct 20];51:237-9. Available from: http://www.ijpmonline.org/text.asp?2008/51/2/237/41667



   Introduction Top


Oncocytoma is defined as a neoplasm composed exclusively or predominantly of oncocytes, which are large and polygonal cells with eosinophilic cytoplasm because of abnormal accumulation of mitochondria. [1]

Oncocytoma of the adrenal is very rare and less than 25 cases are reported in the English literature. [2] Most of the reported cases have been benign and nonfunctioning. [3]

Herein, we report a benign functioning oncocytoma of the adrenal.


   Case History Top


A 43-year-old woman complained of flushing, weight gain and hirsutism since 2 years prior to admission. She had also a history of aligomenorrhea.

Physical examination revealed cushingoid face.

Blood pressure and pulse rate were normal (BP = 130/80, PR = 80).

Abdomen was soft with no mass or organomegaly. Laboratory examination showed high testosterone (11.7 ng/ml) and dehydroepiandrosterone (>900 ng/ml). Cortisol, with 1 mg overnight dexamethasone suppression test, became 8.3 µg/dl.

Fasting blood sugar was 222 mg/dl, but other biochemical parameters were within normal limits.

Abdominal CT scan was performed, which showed a well-defined oval-shaped mass in the left adrenal gland located posterior to the tail of the pancreas and anterior to the upper pole of the left kidney [Figure 1].

With the impression of an adrenal mass, the patient was operated and a suprarenal mass was detected. The mass was excised. Gross examination of the mass revealed a well-circumscribed tumor surrounded by a thin rim of capsule. The cut surface was tan-colored [Figure 2]. No necrosis or cystic formation was present.

Microscopically, the tumor was composed of polygonal and large cells with abundant eosinophilic granular cytoplasm. The nuclei were round and large [Figure 3],[Figure 4]. They were predominantly arranged in trabeculae, separated by delicate fibrovascular stroma. No mitosis or necrosis was present. No Lymphovascular or capsular invasion was seen.

Immunohistochemistry revealed diffuse and strong positivity for vimentin and synaptophysin [Figure 5] and negative chromogranin and Cytokeratin.

According to the above findings, we made the final diagnosis of an adrenocortical oncocytoma.

The patient had an uneventful postoperative course and left the hospital 7 days after surgery.

She is doing well now, 3 months after surgery and is being followed up by sonography twice a year, because according to the current criteria, [4],[5] the tumor is considered to be benign.


   Discussion Top


Oncocytic tumors are described from several sites of the body, such as kidney, thyroid and salivary gland, [6] but they have rarely been reported from the adrenal. [7]

Until now, less than 25 cases have been reported. [2],[3],[7] The reported cases have been in patients from 27 to 72 years, with female predominance.

Most of the adrenocortical oncocytomas were well circumscribed, ranging from 2.2 to 15 cm and from 8 to 865 gr. [2]

In our case of a 43-year-old woman, the oncocytoma was of 9 cm size and 195 gr weight.

Most of the cases have been benign and nonfunctioning and incidentally detected during a clinical work-up for another complaint, such as abdominal pain or fatigue. [7]

According to the proposed criteria by Bisceglia et al , [8] our case should be considered as benign, because there was no mitosis, significant atypia and lymphovascular or capsular invasion. Its size is also less than 10 cm.

To the best of our knowledge, the functioning adrenocortical oncocytoma is extremely rare and until now, less than 5 cases have been reported. [1],[2] Our case here presented with Cushing syndrome.

Most investigators advocate the removal of every functioning adrenocortical tumor and any evidence of hormone production is an indication of surgical intervention. [1]

Our patient was good after surgery and symptom-free, 3 months postoperatively.

 
   References Top

1.Xiao GQ, Pertsemlidis DS, Unger PD. Functioning adrenocortical oncocytoma: A case report and review of the literature. Ann Diagn Pathol 2005;9:295-7.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Botsios D, Blouhos K, Vasiliadis K, Asimaki A, Tsalis K, Betsis D. Adrenocortical oncocytoma: A rare tumor of undefined malignant potential. Surg Today 2007;37:612-7.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Song SY, Park S, Kin SR, Suh YL. Oncocytic Adrenocortical carcinomas: A pathological and immunohistochemical study of four cases in comparison with conventional adrenocortical carcinomas. Pathol Int 2004;54:603-10.  Back to cited text no. 3    
4.Juliano JJ, Cody RL, Suh JH. Metastatic adrenocortical oncocytoma: A case report. Urol Oncol 2008;26:198-201.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Corsi A, Riminucci M, Petrozza V, Collins MT, Natale ME, Cancrini A, et al. Incidentally detected giant oncocytoma arising in retroperitoneal heterotopic adrenal tissue. Arch Pathol Lab Med 2002;126:1118-22.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Kitching PA, Patel V, Harach HR. Adrenocortical oncocytoma. J Clin Pathol 1999;52:151-3.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Lee R, Al-Ahmadie H, Boorjian SA, Gonzalez RR, Badillo C, Badillo F, et al. A case of incidental adrenocortical oncocytoma. Nat Clin Pract Urol 2006;3:618-21.  Back to cited text no. 7    
8.Bisceglia M, Ludovico O, Di mattia A, Ben-Dor D, Sandbank J, Pasquinelli G, et al. Adrenocortical oncocytic tumors: Report of 10 cases and review of the literature. Int Surg Pathol 2004;12:23-6.  Back to cited text no. 8    

Top
Correspondence Address:
Bita Geramizadeh
Transplant Research Center, Pathology Department, Shiraz University of Medical Science, Shiraz, PO Box: 71345-1864
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.41667

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

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