Slowly Growing Adrenal Mass: A 20-Year Incubation

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Presentation transcript:

Slowly Growing Adrenal Mass: A 20-Year Incubation Nobuyuki Takahashi, MD, Akiyo Tanabe, MD, PhD, Yuto Yamazaki, MD, Hironobu Sasano, MD, PhD, Hiroshi Kajio, MD, PhD The American Journal of Medicine Volume 130, Issue 11, Pages e479-e483 (November 2017) DOI: 10.1016/j.amjmed.2017.07.008 Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 1 Enhanced abdominal computed tomography at age 48 years showed well-circumscribed adrenal masses measuring 2.0 cm in diameter in the right adrenal gland (A) and 2.5 cm in the left (B) (arrows). The size of left adrenal mass increased to 7.3 cm in diameter at the age of 65 years (C). The mass contained tiny calcifications at the periphery of the mass. The size of left adrenal mass increased to 9.7 cm in diameter at the age of 68 years (D). The American Journal of Medicine 2017 130, e479-e483DOI: (10.1016/j.amjmed.2017.07.008) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 2 Iodine-131-6-iodochoresterol scintigraphy showed active uptake in the right adrenal mass (arrow); no uptake in the large left adrenal mass was evident. The American Journal of Medicine 2017 130, e479-e483DOI: (10.1016/j.amjmed.2017.07.008) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 3 Gross pathology specimen of the left adrenal mass: a round, well-circumscribed, encapsulated, and moderately firm lesion that measured 9 × 6 × 7 cm. The cut surface of the tumor was reddish-brown and yellowish in color (A). Histopathologic examination revealed a tumor composed of a hemorrhagic lesion consisting of spotty cavernous dilated vessels with fibrin, coagulated blood, and hyaline degeneration on hematoxylin and eosin staining (B). Adrenal tissue composed of the lipid-rich clear cells that lacked the long cords of the zona fasciculata at the peripheral portion of the tumor (C). The bars represent 1 cm in A, 1 mm in B, and 300 µm in C. The American Journal of Medicine 2017 130, e479-e483DOI: (10.1016/j.amjmed.2017.07.008) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 4 The lipid-rich cells at the periphery of the tumor were immunohistochemically positive for steroidogenic factor-1 (SF-1) (A), 3β-hydroxysteroid dehydrogenase (3βHSD) (B), and steroid 17-α-hydroxylase/17,20-lyase (c-17) (C). The zona fasciculata and reticularis in the adjacent adrenal tissue were atrophic on hematoxylin and eosin staining (D). Immunohistochemical staining of adrenal cells in adjacent tissue was negative for dehydroepiandrosterone sulfotransferase (DHEAST) (E) and locally positive for aldosterone synthase (CYP11B2) (arrow) (F). The bars represent 300 µm in A-C and 2 mm in D-F. The American Journal of Medicine 2017 130, e479-e483DOI: (10.1016/j.amjmed.2017.07.008) Copyright © 2017 Elsevier Inc. Terms and Conditions