|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 1 | Page : 203-204
Virilizing adrenocortical oncocytic neoplasm with uncertain malignant potential in a child: A rare case report
Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
|Date of Web Publication||28-Apr-2016|
Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mardi K. Virilizing adrenocortical oncocytic neoplasm with uncertain malignant potential in a child: A rare case report. Indian J Cancer 2016;53:203-4
Oncocytic adrenocortical neoplasms are rare, usually non-functioning tumors, found predominantly in adults. Adrenocortical oncocytic neoplasm of uncertain malignant potential are exceptionally rare with a handful of cases on record so far.
A 14-year-old girl presented with hirsuitism. An ultrasound showed an 18 × 8 × 7 cm solid mass lesion of heterogeneous echotexture with areas of necrosis in the left adrenal gland. Biochemical parameters were within normal limits except high testosterone (147 ng/ml) and dehydroepiandrosterone (980 ng/ml).
Ultrasound-guided FNAC of the left adrenal mass was conducted. FNA smears revealed numerous clusters as well as a dispersed population of round to polygonal cells with abundant densely basophilic granular cytoplasm, eccentrically placed round nucleus with prominent nucleolus [Figure 1]. There were no mitotic figures.
|Figure 1: FNAC smear showing clusters of oncocytes with abundant granular basophilic cytoplasm and eccentrically placed round nucleus. (Giemsa, ×40)|
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On gross examination, the excised mass was completely encapsulated and measured 18 × 8.0 × 7.0 cm with smooth external surface. Cut section was yellow to brown with focal areas of hemorrhage and necrosis. Microscopically, the tumor showed nests and diffuse sheets of polygonal cells with abundant granular eosinophilic cytoplasm, eccentric round nuclei with central nucleoli. [Figure 2]. The nests of cells were surrounded by capillary network. Focal nuclear atypia was seen, but mitotic figures were absent. However, focal capsular invasion and necrotic areas were present. The tumor was diagnosed as adrenocortical oncocytic neoplasm of uncertain malignant potential.
|Figure 2: Sheets of oncocytic cells with interspersed sinusoidal capillaries (H and E, ×40)|
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Functioning adrenocortical oncocytomas are extremely rare, and most reported patients are 40-60 years of age.
The biologic behavior of adrenocortical neoplasms is the most important practical problem. Bisceglia et al. proposed new criteria that modified the Weiss system, which was used previously. According to this system, if the tumor exhibits any of the major criteria (high mitotic activity, atypical mitoses, or venous invasion), it is considered malignant; if the tumor exhibits any of the minor criteria (large size, necrosis, capsular or sinusoidal invasion), it is considered to have uncertain malignant potential; and none of these features indicates a benign tumor.
Borderline adrenal oncocytomas seem to have a benign clinical behavior. The patient will be followed-up to check for any recurrence or metastases every 6 months. In our patient, the hirsuitism resolved gradually following surgery. The patient is still alive with no metastases one year after the surgery.
| » References|| |
Kurek R, Von Knobloch R, Feek U, Heidenreich A, Hofmann R. Local recurrence of an oncocytic adrenocortical carcinoma with ovary metastasis. J Urol 2001;166:985.
Peppa M, Karamitopoulou E, Nikolopoulos P, Peros G, Economopoulos T, Raptis SA, et al
. Large adrenal oncocytoma with uncertain malignant potential: Case report and review of Literature. Endocr Pract 2010;16:641-5.
Lim YJ, Lee SM, Shin JH, Koh HC, Lee YH. Virilizing adrenocortical oncocytoma in a child: A case report. J Korean Med Sci 2010;25:1077-9.
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 J Surg Pathol 2004;12:231-43.
Medeiros LJ, Weiss LM. New developments in the pathologic diagnosis of adrenal cortical neoplasms. Am J Clin Pathol 1992;97:73-83.
[Figure 1], [Figure 2]