Case Report: Challenges on diagnosis and therapy of malignant adrenal oncocytic neoplasm

Background: Adrenal masses are common incidental findings, most of which are benign and non-functional. Malignant adrenal tumors, however, differ from their benign counterpart and confer poor prognosis. In addition, the oncocytic variants of these tumors present challenges to clinicians owing to their unique biologic behavior and rarity. Case presentation: We present a case report of a 61-year-old male with a T2N0M0 adrenocortical oncocytic neoplasm of the right adrenal gland. The patient complained of worsening right upper quadrant abdominal pain and was diagnosed with a right adrenal mass after an abdominal CT-scan examination two weeks before. Subsequently, the patient underwent open adrenalectomy due to a history of abdominal surgery. Due to unique oncocytic biologic behavior, we used the Lin–Weiss–Bisceglia criteria to predict a malignancy instead of the Weiss system. We only found one malignant criterion, which showed a small tumor invasion on the vascular bed on one histopathological section. Thus, we diagnosed it as malignant adrenocortical oncocytic neoplasm. Furthermore, the PET Scan showed no residual mass or pathological metabolic activity on the tumor bed and metastatic sign. Conclusions: The diagnosis of the malignant oncocytic adrenal case is based on the histopathological criteria. Based on this case, we suggest a thorough histopathological examination to determine malignant criteria in adrenal neoplasm cases.

Oncocytic Variant of Adrenocortical Carcinoma: Case Report of a Rare Malignancy

Adrenocortical carcinoma is a rare cancer. Oncocytic tumors of the adrenal gland are rarer. Most Oncocytic Adrenal Neoplasms are benign and carry favourable prognosis. They are classified as oncocytoma, oncocytic neoplasm of uncertain malignant potential and oncocytic adrenal carcinoma. The malignant nature of oncocytic neoplasm of adrenal gland can only be confirmed on histopathology. We report a case of a 55-year-old male with newly diagnosed hypertension being evaluated for left adrenal mass concerning for adrenocortical carcinoma. Open radical left adrenalectomy and nephrectomy was done and histopathology confirmed oncocytic variant of adrenocortical carcinoma based on Lin-Weiss-Bisceglia scoring system which has been developed particularly for oncocytic type of tumor. Though rare, oncocytic neoplasm has to be considered as one of the differential diagnoses of adrenocortical mass, especially those presenting as a large mass because malignant oncocytic neoplasm of adrenal gland as large as 23cm have been reported. Imaging modalities like ultrasonography, computed tomography or magnetic resonance imaging, though useful in evaluating an adrenocortical mass, cannot predict malignant nature of an oncocytic neoplasm. Diagnosis of adrenocortical carcinoma is therefore reliably made only after histopathological examination of the surgical specimen. Surgical resection in those presenting with nonmetastatic resectable disease remains the mainstay of ACC treatment. Oncocytic ACC compared with conventional ACCs matched for age, gender, disease stage and status of surgical resection, shows significant better overall survival thus representing more indolent variant of an aggressive and often fatal disease.

Adrenocortical neoplasm of uncertain malignant potential with a myelolipomatous component

Macroscopic fat inside an adrenal lesion on CT is pathognomonic for myelolipoma, a benign neoplasm. Without macroscopic fat, it can be difficult to discern the nature of an indeterminate adrenal mass on imaging. One possible diagnosis for an indeterminate lesion without macroscopic fat is an adrenal oncocytic neoplasm (AON). Despite its typical benign presentation cases of malignant AON have been reported. Patients with malignant AON are often not surgical candidates and survival for unresected disease is 20%–35%. We present the third report of an AON of uncertain malignant potential (AONUMP) associated with a macroscopic fatty component with the largest reported size and longest duration of follow-up in the literature. This report details diagnostic and therapeutic challenges posed by AONUMP. This case highlights how pathognomonic radiographical findings associated with benign myelolipoma might mask rare, potentially malignant, lipomatous tumours.

Sonographic Detection of an Oncocytic Neoplasm of the Thyroid Gland

Oncocytic neoplasms of the head and neck arise from a dysfunction of the mitochondria. These cells are often called Hürthle cells and recognized as one of the rarest forms of thyroid cancer. Diagnostic imaging is usually performed by sonography with a fine-needle aspiration following the sonogram. A case is presented of an oncocytic neoplasm that was initially identified sonographically. The mass was then characterized using the thyroid imaging reporting and data system, followed by a fine-needle aspiration and gene expression classifier to obtain additional information about the diagnosis. The use of sonography followed by biopsy helped to determine the proper treatment of the neoplasm in the thyroid gland.