Division of Dermatopathology, Department of Pathology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH; and.
Department of Surgery, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH.
Am J Dermatopathol. 2024 Oct 1;46(10):696-699. doi: 10.1097/DAD.0000000000002816. Epub 2024 Aug 14.
Adrenocortical carcinoma is a very rare oncologic condition with poor prognosis that usually metastasizes to the lungs, liver, local lymph nodes, and peritoneum at initial presentation. However, skin metastasis is very uncommon and has rarely been reported even in advanced stages of the disease. We present a case of a 41-year-old man with a known history of adrenocortical carcinoma of the right adrenal gland that presented with an arm mass. The histopathologic sections showed a multinodular necrotic malignant neoplasm in dermis and subcutaneous fat composed of atypical epithelioid cells with ample granular cytoplasm and pleomorphic vesicular nuclei with frequent intranuclear inclusions and atypical mitoses. The immunohistochemical stains showed tumor cells that were strongly positive for synaptophysin and inhibin, only focally positive for Melan-A, and negative for AE1/AE3. The histopathologic features and the immunohistochemical profile confirmed the diagnosis of metastatic carcinoma consistent with adrenal cortical origin. The diagnosis can be difficult (especially when no clinical data are provided), and an immunohistochemical battery is often useful in distinguishing this tumor from other tumors with similar cytomorphological features.
肾上腺皮质癌是一种非常罕见的预后不良的肿瘤疾病，通常在初次就诊时就会转移到肺部、肝脏、局部淋巴结和腹膜。然而，皮肤转移非常罕见，即使在疾病的晚期也很少有报道。我们报告了一例 41 岁男性，患有右肾上腺皮质癌，表现为手臂肿块。组织病理学切片显示真皮和皮下脂肪中存在多结节坏死性恶性肿瘤，由具有丰富颗粒状细胞质和多形性泡状核的非典型上皮样细胞组成，核内常有包涵体和非典型有丝分裂。免疫组织化学染色显示肿瘤细胞对突触素和抑制素强烈阳性，仅对 Melan-A 局灶性阳性，AE1/AE3 阴性。组织病理学特征和免疫组化特征证实了转移性皮质来源癌的诊断。诊断可能具有一定难度（尤其是在没有临床数据提供的情况下），免疫组织化学检测在鉴别具有相似细胞学特征的其他肿瘤方面通常很有用。
