Primary Adrenal Gastrointestinal Stromal Tumor (GIST): a Rarest Incidentaloma and Diagnostic Challenge
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CASE REPORT
Primary Adrenal Gastrointestinal Stromal Tumor (GIST): a Rarest Incidentaloma and Diagnostic Challenge Akanksha Bhatia 1 & Arvind Ahuja 1
&
Hemant Goel 2 & Minakshi Bhardwaj 1
Received: 20 May 2020 / Accepted: 17 July 2020 # Indian Association of Surgical Oncology 2020
Introduction Gastrointestinal stromal tumors (GISTs), although the commonest mesenchymal tumor of the gastrointestinal tract (GIT), are rare, accounting for < 1% of all malignancies of the GIT [1]. It is seen commonly in older adults with an equal male to female predilection. Apart from the stomach, it is also seen in the jejunum and ileum (30%), duodenum (5%), and colorectum (5%) and rarely in the esophagus and appendix [2]. Extraintestinal GISTs are extremely rare, and to the best of our knowledge, only two cases of primary GIST arising from the adrenal gland have been described in the literature so far. We present here a case of primary left adrenal GIST detected incidentally in a 57-year-old male who underwent left nephrectomy for left nephrolithiasis and hydronephrosis.
Case Report A 57-year-old male presented with complaint of abdominal pain for the past 7 months. Ultrasound (USG) and contrast-enhanced computed tomography (CECT) were done which showed left renal calculus with left pelviureteric junction (PUJ) obstruction and hydronephrosis, along with a left adrenal mass (Fig. 1). Patient was taken for left renal nephrectomy. Intraoperatively, a 2 × 2-cm suspicious solid mass present in the left suprarenal region. Excision of this mass along with simple left nephrectomy was done. On histopathological examination, sections from the kidney showed features of chronic pyelonephritis with * Arvind Ahuja [email protected] 1
Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
2
Department of Urology, Atal Bihari Vajpayee Institute of Medical Sciences|, Dr Ram Manohar Lohia Hospital, New Delhi, India
hydronephrosis and nephrolithiasis. Sections from the adrenal mass showed a tumor with a biphasic pattern. The epithelioid pattern comprised lobules of polygonal cells separated by fibrocollagenous stroma spindle cell pattern showing sheets and short fascicles of plump to spindle-shaped cells with nuclear palisading and vague pseudorosettes with extensive myxoid replace degeneration with stroma (Fig. 2). These polygonal cells showed mild to moderate nuclear pleomorphism, with vesicular nucleus and abundant amount of eosinophilic granular cytoplasm. No mitosis was seen. Many lymphoid aggregates forming lymphoid follicles were also noted. At the periphery, normal adrenal parenchymal tissue was identified. Based on morphology, a wide range of differential diagnoses was kept which included primary adrenocortical tumor, mesenchymal tumors, and neuroendocrine tumor. A large panel of immunohistochemical (IHC) stains was applied because of polymorphic morphological features. The tumor cells showed diffuse positivity for CD117, DOG1, CD34, CD99, S100, and syn
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