Adrenal Cortex Neoplasms ; diagnosis ; pathology ; Adrenocortical Adenoma ; diagnosis ; pathology ; Aged ; Humans ; Immunohistochemistry ; Male ; Myxoma ; diagnosis ; pathology

Leptomeningeal carcinomatosis occurs in approximately 5% of patients with cancer. The most common cancers involving the leptomeninges are breast, lung cancer and melanoma. However, gastric adenocarcinoma has been rarely reported with leptomeningeal carcinomatosis. The presenting manifestations are usually headache, visual disturbances and seizures. We report a case of leptomeningeal metastasis that presented as a gastric cancer. A 49-year-old woman was admitted to our hospital with the symptoms of headache and melena for 10 days. The endoscopy showed a thickening of the folds of the stomach compatible with the diagnosis of a Borrman type IV gastric cancer. The biopsy revealed a signet ring cell carcinoma. The MRI of brain showed no abnormal findings; however, the patient complained of an intractable persistent headache, nausea and vomiting on admission day 6. The cytology examination of the cerebrospinal fluid supported the diagnosis of metastatic signet ring cell carcinoma.
Adrenal Cortex Hormones ; Carcinoma, Signet Ring Cell/*diagnosis/pathology/surgery ; Female ; Humans ; Mannitol ; Meningeal Neoplasms/*diagnosis/pathology/surgery ; Middle Aged ; Stomach Neoplasms/*diagnosis/pathology/surgery

To investigate the diagnosis and surgical treatment of adrenocortical oncocytoma. The clinical data from three cases of adrenocortical oncocytomas (ACOs) were retrospectively analyzed and discussed in light of the relevant literature. In these three cases, one presented with virilization, while the other two cases had no typical clinical features. The tumor was completely encapsulated and was non-invasive. Microscopically, the tumor cells showed neither mitosis nor necrosis, with abundant eosinophilic cytoplasm. No recurrence or metastasis was discovered after close follow-up observation for 12-24 months. Adrenocortical ACOs are rather rare, and most of them are benign. It was hard to make a confirmed diagnosis of ACOs before surgery. Resection of tumor is the best choice, and close follow-up observation is essential.
Adenoma, Oxyphilic ; diagnosis ; pathology ; surgery ; Adrenal Cortex Neoplasms ; diagnosis ; pathology ; surgery ; Adrenocortical Adenoma ; diagnosis ; pathology ; surgery ; Child ; Female ; Humans ; Middle Aged

The metabolic alterations caused by hyperaldosteronism are being increasingly recognized and have generated considerable interest among the medical fraternity. Hyperaldosteronism is suspected to have a pivotal role in the patho-physiology of congestive cardiac failure where it has been studied extensively. But its effects on calcium metabolism, parathyroid metabolism and renal handling of calcium are less well described. Recent experimental models have shed light into the roles played by previously unknown mechanisms in causing these metabolic alterations. We hereby report a case of primary hyperaldosteronism due to adrenal adenoma (Conn's syndrome) who presented with a myriad of clinical features including symptomatic hypocalcemia, significant weight loss along with uncontrolled hypertension for a prolonged period before eventually detected to have primary hyperaldosteronism. Surgical removal of the causative tumor resulted in prompt disappearance of all the symptoms and signs and regain of lost weight.
Adrenal Cortex Neoplasms/*complications/diagnosis/pathology/surgery ; Adrenocortical Adenoma/*complications/diagnosis/pathology/surgery ; Adult ; Female ; Humans ; *Hyperaldosteronism/complications/etiology/physiopathology ; Hypocalcemia/*etiology ; Pregnancy ; Treatment Outcome

The coexistence of myelolipoma within adrenal cortical adenoma is extremely rare, for both tumors present usually as separate entities. There are only 16 such cases reported worldwide. To the best of our knowledge, the case we reported here is the first one of myxoid adrenal cortical adenoma associated with myelolipoma reported. A 32-year-old Chinese woman with 4-year history of hypertension was presented in our study. Computed tomography (CT) of the abdomen showed a large heterogeneously-enhancing mass (4.5 cm in diameter) in the left suprarenal region. Clinical history and laboratory results suggest a metabolic disorder as Conn's syndrome. The patient underwent a left adrenalectomy, and a histopathological study confirmed the mass to be a myxoid adrenal cortical adenoma containing myelolipoma. The patient was postoperatively well and discharged uneventfully. In the present case report, we also discuss the etiology of simultaneous myelolipoma and adrenal adenoma associated with Conn's syndrome, and the methods of the diagnosis and differential diagnosis.
Adrenal Cortex Neoplasms ; complications ; diagnosis ; pathology ; Adrenocortical Adenoma ; complications ; diagnosis ; pathology ; Adult ; Biomarkers, Tumor ; metabolism ; Female ; Humans ; Hyperaldosteronism ; complications ; Inhibins ; metabolism ; Myelolipoma ; complications ; diagnosis ; pathology ; Neoplasms, Multiple Primary ; complications ; diagnosis ; pathology ; Synaptophysin ; metabolism ; Tomography, X-Ray Computed ; Vimentin ; metabolism

Primary adrenocortical carcinoma (ACC) is a rare tumor and its usual sites of metastasis are the lung (71%), lymph node (68%), liver (42%), and bone (26%). However, intracaval invasion extending into the right atrium is very rare and spontaneous regression of tumor burden in adrenal carcinoma is also rare. We report a case of ACC with direct invasion of the inferior vena cava and right atrium. A 34-yr-old male patient presented with progressive dyspnea, weight loss, and poor oral intake over 3 months. Non-functioning ACC with direct invasion of the inferior vena cava and right atrium was confirmed by imaging, pathologic, and hormonal study. Chemo-radiotherapy was attempted. However, tumor burden was not changed, but rather toxic hepatitis and thrombocytopenia were developed. His subjective symptoms and general conditions were improved after 1 month of conservative management and the patient was discharged. During clinical follow-up, this tumor showed spontaneous regression.
Vena Cava, Inferior/*pathology ; Tomography, X-Ray Computed ; Remission Induction ; Neoplasm Metastasis ; Male ; Humans ; Heart Neoplasms/pathology/*secondary ; Heart Atria/*pathology ; Follow-Up Studies ; Echocardiography ; Biopsy ; Adult ; Adrenocortical Carcinoma/*diagnosis/*pathology ; Adrenal Cortex Neoplasms/*diagnosis/*pathology

Adrenal Cortex Hormones ; therapeutic use ; Antiviral Agents ; therapeutic use ; Diagnosis, Differential ; Granulomatosis with Polyangiitis ; diagnosis ; Humans ; Lung Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Lymphomatoid Granulomatosis ; diagnostic imaging ; drug therapy ; pathology ; Prognosis ; Radiography ; Sarcoidosis ; diagnosis ; Tuberculosis, Pulmonary ; diagnosis

OBJECTIVETo study the clinicopathologic features and expression of epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) in adrenocortical tumors.

METHODSForty-two cases of adrenocortical tumors operated at the Beijing Union Medical College Hospital during the period from July, 2001 to July, 2010 were retrospectively reviewed. Immunohistochemical study for EGFR and VEGF was carried out. The clinical information and follow-up data were analyzed.

RESULTSThe cases included 21 adrenocortical carcinomas (ACC) and 21 adrenocortical adenomas (ACA). Nine patients suffered from primary aldosterone syndrome, including 8 cases with ACA and 1 case with ACC. The average tumor size, tumor weight, and duration between disease onset and diagnosis in the 21 cases of ACC were 11.7 cm, 542 g and 8.5 months, respectively. This was in contrast to 3 cm, 9.8 g and 45.6 months, respectively in cases of ACA. Histologically, the WEISS score in all the 21 cases of ACA was ≤ 2 (average = 0.9). None of the ACC cases had score less than 4 (average = 6.6). The presence of sinus invasion correlated with tumor metastasis (P < 0.01). Immunohistochemical study showed that EGFR was expressed in 61.9% of ACC patients (13/21), whereas EGFR staining was mostly negative in ACA (except for weak staining in 5 cases and moderate staining in 1 case). The difference of EGFR expression between ACC and ACA was statistically significant (P = 0.030). On the other hand, the positive rate of VEGF in ACC was 71.4% (15/21), including 28.6% (6/21) with strong expression and 28.6% (6/21) with moderate expression. In contrast, the expression rate of VEGF in ACA was 30.0% (7/21), including 14.3% (3/21) with moderate expression. The difference of VEGF expression between ACC and ACA was statistically significant (P = 0.013). There was correlation between VEGF expression and venous invasion (P = 0.028). The average duration of survival in patients with ACC was shorter than that in ACA. The tumor weight in ACC also correlated with prognosis.

CONCLUSIONSTumor size, weight and presence of endocrine symptoms may help in the differential diagnosis between ACC and ACA. A WEISS score of ≥ 3 highly suggests ACC. The presence of sinus invasion is associated with metastasis. EGFR or VEGF expression may also be important in differentiating ACC from ACA.

Adolescent ; Adrenal Cortex Neoplasms ; metabolism ; pathology ; surgery ; Adrenocortical Adenoma ; metabolism ; pathology ; surgery ; Adrenocortical Carcinoma ; metabolism ; pathology ; surgery ; Adult ; Aged ; Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Receptor, Epidermal Growth Factor ; metabolism ; Retrospective Studies ; Survival Rate ; Tumor Burden ; Vascular Endothelial Growth Factor A ; metabolism ; Young Adult