Oncocytic pheochromocytoma of the adrenal gland with preoperative endocrine examination
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CASE REPORT
Oncocytic pheochromocytoma of the adrenal gland with preoperative endocrine examination Kosuke Shibamori • Ko Kobayashi • Naoki Itoh • Takashi Minase • Masaaki Satoh
Received: 1 October 2012 / Accepted: 8 January 2013 / Published online: 31 January 2013 Ó The Japan Society of Clinical Oncology 2013
Abstract We report a case of oncocytic pheochromocytoma of the right adrenal gland in a woman in her sixties with preoperative endocrine examination results. She had no clinical symptoms, but a large right adrenal mass (8.5 9 7.2 cm) was incidentally pointed out. Preoperative endocrine examination was within normal limits except for an increased dehydroepiandrosterone sulfate level. We removed the tumor surgically. It measured 10 9 8 9 5.5 cm, weighed 260 g, and had a solid, bark-like cut surface. Microscopically, the tumor cells were highly eosinophilic, polygonal, and arranged in an alveolar pattern. Immunohistochemically the tumor cells were positive for chromogranin, synaptophysin and CD-56. Based on these results, the tumor combined oncocytoma and pheochromocytoma. Therefore we diagnosed it as oncocytic pheochromocytoma. Keywords Adrenal Oncocytic Pheochromocytoma Dehydroepiandrosterone sulfate
Introduction Oncocytic pheochromocytoma of the adrenal gland is extremely rare. To our knowledge, only 3 cases have been K. Shibamori K. Kobayashi N. Itoh Department of Urology, NTT-East Corporation Sapporo Medical Centre, Sapporo, Hokkaido, Japan K. Shibamori (&) K. Kobayashi Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-ku, Sapporo 064-8543, Japan e-mail: [email protected] T. Minase M. Satoh Department of Pathology, NTT-East Corporation Sapporo Medical Centre, Sapporo, Hokkaido, Japan
reported previously, but there were no preoperative endocrine examination data in those cases [1–3]. We report a case of oncocytic pheochromocytoma of the right adrenal gland in a woman in her sixties with preoperative endocrine examination results.
Case report A female patient in her early sixties came to the hospital regularly for treatment of hypertension and dyslipidemia. She did not have any other symptoms such as headache, sweating, palpitation, or virilization. She had received valsartan 160 mg, benidipine 8 mg, and rosuvastatin calcium 2.5 mg orally, and her blood pressure was stable. In November 2010, she was incidentally found to have a massive, solid abdominal mass by ultrasonography. Contrast-enhanced computed tomography showed that there was a bulky tumor (8.5 9 7.2 cm) in the right adrenal gland that was very close to the liver and inferior vena cava (IVC) (Fig. 1). A nonenhanced, heterogeneous area existed in a portion of the tumor. There was no mass in the liver, lung, or other organs. Magnetic resonance imaging (MRI) with a contrast agent showed that medium or low intensity areas existed in most of the tumor. A high intensity area was dotted on a T2-weighted MRI sequence. Fluoro-18deoxyglucose positron emission tomography revealed no emphatic finding except
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