Krstevska Brankica, Mishevska Sasha Jovanovska, Jovanovic Rubens
Clinic of Endocrinology, Diabetes and Metabolic Disorders, Medical Faculty , Skopje.
Institute of Pathology , Medical Faculty, Skopje, Macedonia.
Rare Tumors. 2016 Dec 7;8(4):6506. doi: 10.4081/rt.2016.6506. eCollection 2016 Nov 17.
Adenomatoid tumors are neoplasms of mesothelial origin, usually occurring in the male and female genital tracts. Extragenital localization sites such as adrenal glands are rare but have been reported. When found in the adrenals, they represent great clinical, radiological and pathological diagnostic challenge, with wide range of differential diagnoses to be considered. We present a case of a 30 years old female, with incidental ultrasound finding of unilateral tumor in the right adrenal gland. Multi slices CT scan was of value in localizing this tumor, but not in the precise diagnosis. The tumor ranged from 5.6 cm to 6.4 cm in greatest diameter. Clinical and hormonal examinations excluded Sy. Cushing, M. Conn and pheochromocytoma. The patient underwent laparoscopic right adrenalectomy. A large tumor (d: 8 × 7 × 3 cm) was removed showing no infiltration of the adrenal cortex or medulla, or extra-adrenal extension into the periadrenal adipose tissue. Histological examination showed numerous cystic spaces lined by flattened cubical epithelial cells. The small cystic spaces were separated by edematous fibrovascular stroma with rare epithelial cells with vacuolated cytoplasm. Immunohistochemical staining was positive with vimentin (+), S100 (+), MCA mesothelial Ag (+), CD 68 (+) and negative with acitin (-), CK7 (-), CD3 (-). Adenomatoid tumor is a rare benign neoplasm that should be added in the differential diagnosis of any adrenal tumor occurring in adrenal gland. The histological and immunohistochemical profiles of this adrenal adenomatoid tumor are very supportive in reaching the diagnosis of this benign tumor of a mesothelial cell origin, helping to avoid invasive treatment.
腺瘤样瘤是一种间皮起源的肿瘤，通常发生于男性和女性生殖道。肾上腺等生殖器外定位部位罕见，但已有报道。当在肾上腺发现时，它们在临床、放射学和病理学诊断方面构成巨大挑战，需要考虑广泛的鉴别诊断。我们报告一例30岁女性，超声偶然发现右侧肾上腺有单侧肿瘤。多层CT扫描对该肿瘤定位有价值，但对精确诊断无帮助。肿瘤最大直径为5.6厘米至6.4厘米。临床和激素检查排除了库欣综合征、原发性醛固酮增多症和嗜铬细胞瘤。患者接受了腹腔镜右肾上腺切除术。切除了一个大肿瘤（直径：8×7×3厘米），未见肾上腺皮质或髓质浸润，也无肾上腺外延伸至肾上腺周围脂肪组织。组织学检查显示有许多由扁平立方上皮细胞衬里的囊性间隙。小囊性间隙被水肿的纤维血管间质分隔，间质中有罕见的胞质有空泡的上皮细胞。免疫组化染色波形蛋白（+）、S100（+）、间皮抗原（+）、CD 68（+）呈阳性，肌动蛋白（-）、细胞角蛋白7（-）、CD3（-）呈阴性。腺瘤样瘤是一种罕见的良性肿瘤，在肾上腺发生的任何肾上腺肿瘤的鉴别诊断中都应予以考虑。该肾上腺腺瘤样瘤的组织学和免疫组化特征对诊断这种间皮细胞起源的良性肿瘤非常有帮助，有助于避免侵入性治疗。
