Jayanth Kalkunte Sriram, Balamurugan S, Sureshkumar Sathasivam, Anandhi Amaranathan, Sree Rekha J, Abdulbasith K M, Rajesh B S, Tajudeen Muhamed
Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Tumori. 2020 Dec;106(6):NP84-NP88. doi: 10.1177/0300891620949656. Epub 2020 Aug 24.
Xanthogranulomatous adrenalitis (XA) is a rare chronic inflammatory disease of the adrenal glands and resembles adrenal neoplasm in clinical and radiologic characteristics. There is no report on XA presenting as a functioning adrenal mass in the literature. We present a case of XA mimicking a functioning adrenocortical carcinoma.
A 52-year-old man presented with right flank pain, fever, vomiting, and loss of appetite for 2 weeks. He had signs of dehydration and elevated blood glucose level. Ultrasonography revealed a right adrenal mass. Contrast-enhanced computed tomography showed lobulated and necrotic mass replacing the right suprarenal gland and encasing the right renal vein, adjacent inferior vena cava, psoas, and diaphragm. There was loss of fat planes with liver and upper pole of the right kidney. Biochemical evaluation indicated increased serum and urine cortisol levels. As a sequel to hypercortisolism-induced hyperglycemia, he developed spontaneous chest wall abscess and bilateral sudden vision loss due to vitreous hemorrhages. Pus and blood culture grew methicillin-sensitive . Adrenal suppressant ketoconazole was administered for better glycemic control. With a diagnosis of locally advanced adrenocortical malignancy, right radical adreno-nephrectomy was performed, and cut section revealed a pus collection of around 100 mL. Histopathology examination showed xanthogranulomatous inflammation involving adrenal gland, Gerota's fascia, psoas, and lymph nodes. Postoperatively, the patient recovered satisfactorily with favorable glycemic control.
XA can mimic adrenal neoplasms both clinically and radiologically and is associated with staphylococcal infection. It warrants surgical excision and culture-based antibiotics and is mostly diagnosed on postoperative histopathology.
黄色肉芽肿性肾上腺炎（XA）是一种罕见的肾上腺慢性炎症性疾病，在临床和放射学特征上类似于肾上腺肿瘤。文献中尚无XA表现为功能性肾上腺肿块的报道。我们报告一例模仿功能性肾上腺皮质癌的XA病例。
一名52岁男性出现右侧腰痛、发热、呕吐和食欲不振2周。他有脱水体征和血糖水平升高。超声检查发现右侧肾上腺肿块。增强计算机断层扫描显示分叶状坏死肿块取代右肾上腺，包绕右肾静脉、相邻的下腔静脉、腰大肌和膈肌。与肝脏和右肾上极的脂肪平面消失。生化评估显示血清和尿皮质醇水平升高。由于高皮质醇血症导致的高血糖，他出现了自发性胸壁脓肿和因玻璃体出血导致的双侧突然视力丧失。脓液和血培养培养出对甲氧西林敏感的……给予肾上腺抑制剂酮康唑以更好地控制血糖。诊断为局部晚期肾上腺皮质恶性肿瘤，行右侧根治性肾上腺肾切除术，切面可见约100 mL的脓液聚集。组织病理学检查显示黄色肉芽肿性炎症累及肾上腺、肾周筋膜、腰大肌和淋巴结。术后，患者恢复良好，血糖控制满意。
XA在临床和放射学上均可模仿肾上腺肿瘤，并与葡萄球菌感染有关。它需要手术切除并使用基于培养的抗生素，大多通过术后组织病理学诊断。
