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Myxoid adrenocortical adenoma with a pseudoglandular pattern
Enrico R Bollito1, Mauro Papotti, Francesco Porpiglia
1Division of Pathology, San Luigi Gonzaga Hospital, Reg. Gonzole, 10-10043 Orbassano, Italy.
Summary
This study describes a rare pseudoglandular myxoid adenoma of the adrenal gland in a hypertensive patient. Accurate diagnosis requires specific immunohistochemical markers to differentiate from metastatic cancers.
Area of Science:
- Endocrinology
- Oncology
- Pathology
Background:
- Myxoid changes are uncommon in adrenocortical tumors, with only eight benign cases previously reported.
- Five of the reported cases exhibited a prominent pseudoglandular component alongside myxoid features.
Observation:
- A 4-cm pseudoglandular myxoid adenoma was resected from a 58-year-old male with mild hypertension.
- Histological examination revealed polygonal cells in a myxoid background, with less than 20% showing classical adrenocortical adenoma features.
- The tumor lacked atypia and mucin markers, displaying an immunophenotype consistent with adrenal origin.
Findings:
- The case was diagnosed as a primary adrenocortical adenoma with an extensive pseudoglandular myxoid pattern.
- Differential diagnosis included metastatic adenocarcinomas, chordomas, and retroperitoneal myxoid mesenchymal tumors.
- Immunohistochemistry for alpha-inhibin and synaptophysin is crucial for accurate diagnosis.
Implications:
- Accurate diagnosis of adrenal myxoid tumors is challenging and requires careful consideration of differential diagnoses.
- Immunohistochemical staining for alpha-inhibin and synaptophysin is recommended to confirm adrenocortical origin.
- Distinguishing these rare adenomas from metastatic tumors is critical for appropriate patient management.