ASIAN
CALMA
FOUNDED 1976
Asian Journal of Surgery
journal homepage: www.e-asianjournalsurgery.com
Asian Journal of Surgery
Letter to Editor
Ectopic adrenocortical nodular hyperplasia mimicking an upper-pole renal-cell carcinoma: A case report
Check for updates
Keywords:
Ectopic adrenocortical nodular hyperplasia Renal cell carcinoma Case report Differential diagnosis
To the editor,
A 32 y woman, who found a mass at the upper pole of right kid- ney for 10 days, was hospitalized. Enhanced MRI showed a 1.5cm × 1.3cm × 0.5 cm mass at the upper pole of right kidney, and the signal intensity of the mass was lower than renal cortex in MRI mDIXON images. Primary diagnosis of MRI was kidney neoplasm. Furthermore, holographic images were obtained and robotic-assisted partial nephrectomy was planned. In the surgery, we found the mass was closely related to the kidney and adrenal gland. Partial nephrectomy and adrenalectomy were operated.
The mass was golden yellow and resembled adrenal tissues in appearance. Postoperative pathology of kidney neoplasm and adre- nal gland tissue were both adrenocortical nodular hyperplasia with congenital developmental malformations. Immunohistochemistry of kidney neoplasm: PAX-8 (-), CK8 (-), S-100 (-), KI-67 (4%+), CD117 (-), HMB-45 (focal+), MelanA (focal+), a-inhibin (partial+), CD3 (a few T cells +), CD20 (a few B cells +). Owing to primary diag- nosis and clinical manifestation, hormones of adrenal gland axis were not tested (see Fig. 1).
The adrenal medulla and cortex are derived from the ectoderm and mesoderm, respectively. The organization and hormone- secreting functions of the two are relatively independent. A small number of adrenal tissues can be ectopic in the celiac trunk, broad ligament, testicular/ovarian adnexa, spermatic cord, and kidney. Ectopic adrenal tissue is a developmental abnormality of the adre- nal gland that can occur along the path of embryonic migration. The most frequently reported sites of ectopic adrenal tissues are the ce- liac trunk region (32%), broad ligament (23%), testicular adnexa (7.5%) and spermatic cord (1.2%).1 Most ectopic adrenal tissues are nonfunctional.2 Both CT and MR have an important role in the diag- nosis of adrenal ectopia. CT can distinguish adrenal-renal fusion
a.
b.
C.
d.
relationships caused by adrenocortical adenomas,3 MR can provide enhanced imaging features,4 but both of them have difficulty in the differential diagnosis of renal mass considering adrenal ectopia. The correct diagnosis of adrenal ectopia can be made pathologically by morphologic features, and the adjunctive use of immunohisto- chemistry in problematic cases is sufficient.5 For the differentiation and diagnosis of renal mass, adrenal ectopia is rare, but should still be considered.
Funding
This study was funded by: Youth Research Project of Fujian Pro- vincial Health Commission (Project Number: 2019-2-47; Recipient: Jiaxuan Qin).
Declaration of competing interest
All authors declare there is no conflict of interest.
References
1. Harrison LA, McMillan JH, Batnitzky S, et al. MR appearance of an ectopic intra- spinal adrenal cortical adenoma. AJNR Am J Neuroradiol. 1990; 11(6): 1185-1187.
2. Zhang J, Liu B, Song N, et al. An ectopic adreocortical adenoma of the renal sinus: a case report and literature review. BMC Urol. 2016;16:3.
3. Mahadevia S, Rozenblit A, Milikow D, et al. Renal-adrenal fusion: instance of an adrenal adenoma mimicking a solid renal mass at CT-case report. Radiology. 2009;251(3):808-812.
4. Miller C, Raza SJ, Davaro E, et al. Adrenal-renal fusion with adrenal cortical ad- enoma and ectopic adrenal tissue, presenting as suspected renal mass: a case report. Curr Urol. 2020;14:163-165.
5. Ye H, Yoon GS, Epstein J, et al. Intrarenal ectopic adrenal tissue and renal-adrenal fusion: a report of nine cases. Mod Pathol. 2009;22:175-181.
Dawei Lin
Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China
Center of Diagnosis and Treatment of Urinary System Diseases, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China
The Key Laboratory of Urinary Tract Tumors and Calculi of Xiamen City, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China
The Third Clinical Medical College of Fujian Medical University, Xiamen, Fujian, 361003, China
Jiaxuan Qin ** , Jinchun Xing”
Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China
Center of Diagnosis and Treatment of Urinary System Diseases, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China
The Key Laboratory of Urinary Tract Tumors and Calculi of Xiamen City, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China
*Corresponding author. Corresponding author.
E-mail addresses: jiaxuanqin@163.com (J. Qin),
jinchun_xing@163.com (J. Xing).
31 October 2022 Available online 28 November 2022