Kasajima Atsuko, Nakamura Yasuhiro, Adachi Yuzu, Takahashi Yayoi, Fujishima Fumiyoshi, Chiba Yutaka, Uehara Shigeki, Watanabe Mika, Sasano Hironobu
Department of Pathology, Tohoku University Hospital, Sendai, Japan.
Pathol Int. 2014 Apr;64(4):183-8. doi: 10.1111/pin.12154.
Oncocytic adrenocortical neoplasm is characterized by abundant eosinophilic cytoplasm containing mitochondria, occasional nuclear atypia and diffuse growth pattern. Oncocytic adrenocortical neoplasm arising in adrenal rest is, however, extremely rare. We report a case of oncocytic adrenocortical neoplasm arising in adrenal rest of the broad ligament with associated marked lipomatous metaplasia. A well circumscribed tumor was accidentally detected in the pelvic cavity of a 29 year old Japanese woman, adjacent to the broad ligament of the uterus. The tumor was composed of large eosinophilic cells associated with diffuse growth pattern and abundant mature adipose tissue admixed with foci of clear cells. Both steroidgenic factor 1 (SF-1) and alpha-inhibin were immunohistochemically positive in tumor cells. Abundant mitochondria detected by immunohistochemical and electron microscopic examination confirmed the diagnosis of oncocytic adrenocortical neoplasm. The absence of necrosis, capsular and vascular invasion as well as the low mitotic index indicated the benign potential of this tumor. The tumor cells were also positive for dehydroepiandrosteron-sulfotransferase (DHEA-ST), 17β-hydroxysteroid dehydrogenase type 5 (17β-HSD5), 3β-hydroxysteroid dehydrogenase (3β-HSD) and steroid 17α-hydroxylase (P450-c17), suggesting a possible production of testosterone of this tumor. This is the first reported case of oncocytic adrenocortical adenoma arising in adrenal rest of the broad ligament.
嗜酸性肾上腺皮质肿瘤的特征是含有线粒体的丰富嗜酸性细胞质、偶尔的核异型性和弥漫性生长模式。然而，起源于肾上腺残余组织的嗜酸性肾上腺皮质肿瘤极为罕见。我们报告一例起源于阔韧带肾上腺残余组织的嗜酸性肾上腺皮质肿瘤，并伴有明显的脂肪化生。在一名29岁日本女性的盆腔内，意外发现一个边界清晰的肿瘤，毗邻子宫阔韧带。肿瘤由大嗜酸性细胞组成，具有弥漫性生长模式，并有丰富的成熟脂肪组织，混有透明细胞灶。免疫组化显示肿瘤细胞中类固醇生成因子1（SF-1）和α-抑制素均呈阳性。免疫组化和电子显微镜检查发现大量线粒体，证实了嗜酸性肾上腺皮质肿瘤的诊断。无坏死、包膜和血管侵犯以及低有丝分裂指数表明该肿瘤具有良性潜能。肿瘤细胞脱氢表雄酮硫酸转移酶（DHEA-ST）、17β-羟类固醇脱氢酶5型（17β-HSD5）、3β-羟类固醇脱氢酶（3β-HSD）和类固醇17α-羟化酶（P450-c17）也呈阳性，提示该肿瘤可能产生睾酮。这是首例报道的起源于阔韧带肾上腺残余组织的嗜酸性肾上腺皮质腺瘤病例。
