Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2009  |  Volume : 52  |  Issue : 1  |  Page : 130--131

Ectopic adrenocortical rest in the wall of the large intestine


Amanjit Bal1, Amit Kumar Adhya1, JK Mahajan2,  
1 Department of Histopathology, Post Graduate Institute of Medical Sciences and Research, (PGIMER), Sector-12, Chandigarh - 160 012, India
2 Department of Pediatric Surgery, Post Graduate Institute of Medical Sciences and Research, (PGIMER), Sector-12, Chandigarh - 160 012, India

Correspondence Address:
Amanjit Bal
Department of Histopathology, Post Graduate Institute of Medical Sciences and Research (PGIMER), Chandigarh - 160012
India




How to cite this article:
Bal A, Adhya AK, Mahajan J K. Ectopic adrenocortical rest in the wall of the large intestine.Indian J Pathol Microbiol 2009;52:130-131


How to cite this URL:
Bal A, Adhya AK, Mahajan J K. Ectopic adrenocortical rest in the wall of the large intestine. Indian J Pathol Microbiol [serial online] 2009 [cited 2021 Oct 16 ];52:130-131
Available from: https://www.ijpmonline.org/text.asp?2009/52/1/130/44980


Full Text

Sir,

Ectopic adrenal cortical tissue is very rarely found at sites other than around the adrenal gland or in and around the urogenital structures. Single cases have been reported in the wall of the gall bladder, the pancreas, the mediastinum, the lungs and in several cases in the liver. [1],[2],[3],[4],[5] We report a case of ectopic adrenal cortical tissue in the wall of the large intestine. In English literature, this is the first report of heterotopic adrenal tissue at this site. Most of these lesions are clinically silent but may give rise to complications such as adreno-cortico-tropic hormone (ACTH) hypersecretion, cyst formation, or neoplastic transformation.

A 2-day-old infant presented with exostrophy and a prolapsed matted bowel from the perineum. During exploratory surgery, the prolapsed bowel loops were found to be continuous with the rectum. The bowel loop was excised and sent for a histopathological examination. On gross examination, the bowel loops were found to be extensively matted. The serosal aspect was covered with a greenish exudate; however, no perforation was identified. Along its length, the mucosa showed mild edema. A small nodule measuring 0.8x0.5x0.3cm was identified in the wall of one of the loops [Figure 1]. On slicing the nodule, the cut surface was dark brown in color. A histopathological examination of the bowel loops revealed a normal mucosal epithelium of the small and large intestine. The submucosa showed fibrosis, edema and congested blood vessels. There was evidence of acute serositis. The serosal aspect of the large intestine showed the presence of nodules of adrenocortical tissue [Figure 2A] and [Figure 2B]. No medullary tissue was identified within the ectopic rest. There was no evidence of any hyperplasia or neoplastic pathology within the ectopic adrenal cortical rest.

Aberrant adrenal tissue is a rather common finding near the adrenal gland. In 1970, Morgagni initially described yellowish nodules resembling adrenal tissue adjacent to the main adrenal glands. [3] Since then, several reports have been published locating ectopic adrenal tissue in various sites, most frequently in relation to the kidney and the genital regions owing to the close embryologic proximity of the adrenal cortical primordia to the developing gonad and mesonephric kidney. Of these, approximately 80 cases have been described in male genital structures. [5] Adrenal cortical remains located outside the region of the embryonic or adult urogenital tract are very rare and have been regarded as strange occurrences that defy embryological concepts.

Adrenal rests situated distant from the original gland are composed entirely of cortical adrenal tissue without any medullary cells, but the more proximal ones may contain medulla. Most cases of ectopic adrenal tissue have been found incidentally during surgical procedures or in autopsy material. The clinical implications of these remains are essential in surgical intervention in such patients. In patients who have undergone bilateral adrenalectomy due to pathologic ACTH production, compensatory hyperplasia of the ectopic adrenal tissue may be responsible for the recurrence of the disease. Another clinical aspect is the possibility of the development of malignant diseases in the ectopic adrenal cells. Although the occurrence of neoplasms in ectopic adrenal nodules is far from common, pheochromocytomas, Leydig cell tumors and adrenal adenomas have been reported. [4],[5]

It is important to recognize these ectopic adrenal rests and surgically remove them owing to their potential complications.

References

1Basar M, Erdogan S, Aydoganli L, Basar H, Kulacoglu S, Akalin Z. Aberrant adrenal cortical tissue adjacent to immature testis. Arch Ital Urol Androl 1997;69:141-2.
2Oguzkurt P, Oz S, Kayaselcuk F. Ectopic adrenal tissue: An incidental finding during inguinoscrotal operations in children. Hernia 2002;6:62-3.
3Abe T, Matsuda H, Shindo J, Nonomura K, Koyanagi T. Ectopic pheochromocytoma arising in the spermatic cord 5 years after removal of bilateral carotid body tumors and adrenal pheochromocytomas. Int J Urol 2000;7:110-1.
4Medeiros LJ, Anasti J, Gardner KL, Pass HI, Nieman LK. Virilizing adrenal cortical neoplasm arising ectopically in the thorax. J Clin Endocrin Metab 1992;75:1522-5.
5Savas C, Candir O, Bezir M, Cakmak M. Ectopic adrenocortical nodules along the spermatic cord of children. Int Urol Nephrol 2001;32:681-5.