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Case Reports: Rare disease
Oncocytic adrenocortical tumour presenting as an incidentaloma: a diagnostic challenge
  1. Carol D Cardona Attard1,
  2. Zachary Gauci1,
  3. Noel Gatt2,
  4. Warren Scicluna3 and
  5. Mario J Cachia1
  1. 1Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta
  2. 2Pathology Department, Mater Dei Hospital, Msida, Malta
  3. 3Medical Imaging Department, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Carol D Cardona Attard; carolcharm18{at}yahoo.com

Abstract

Oncocytic adrenocortical neoplasms are a rare histopathological subtype of adrenal tumours which are usually benign and, if malignant, are less likely to metastasise. We report a case of a non-functioning oncocytic adrenocortical tumour, identified incidentally in a middle-aged woman. It was initially reported as a left-sided 3.5×3.4×5.6 cm adrenal adenoma. It however increased in size to 5.4×4.0×4.3 cm on follow-up scans. Subsequent review of the scans revealed an indeterminate lesion with a precontrast density of 30 Hounsfield units, an absolute washout of 42.6% and a relative washout of 28.6%. As a result, laparoscopic left adrenalectomy was performed. Histology confirmed oncocytic adrenocortical carcinoma when using the Lin-Weiss-Bisceglia system, though it was deemed benign when using the Helsinki scoring system. There has been no evidence of recurrence to date. This case highlights the potential pitfalls in the diagnosis of oncocytic neoplasms and the increased specificity of the Helsinki score in assessing metastatic potential.

  • Adrenal disorders
  • Endocrine cancer
  • Pathology
  • Radiology

https://doi.org/10.1136/bcr-2022-250900

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    Footnotes

    • Contributors All authors have made a significant contribution to the write-up of the paper, and all were involved in the conception, design, acquisition and interpretation of data. CDCA and ZG drafted the initial version of the manuscript, while NG, WS and MJC have revised it critically. All authors approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.