Cytodiagnosis of myxoid adrenocortical carcinoma and role of immunocytochemistry to differentiate it from renal cell carcinoma

Abstract

Adrenocortical carcinoma (ACC) is a rare malignancy and cytodiagnosis of this tumor is not routinely encountered by a cytopathologist. Here, we report a case of ACC initially diagnosed by computed tomography (CT)-guided fine needle aspiration cytology (FNAC) with the help of immunocytochemistry. A 48-year-old lady presented with flank pain and abdominal mass for the last 6 months. A CT scan of her abdomen revealed a large mass arising from the upper part of the left kidney. CT-guided FNAC was performed. Cytologic smears showed pleomorphic large cells arranged discretely and in small aggregates against a myxoid background. The cells had a high nucleocytoplasmic ratio, anisonucleosis and conspicuous nucleoli. Based on cytomorphology, differential diagnoses of ACC and renal cell carcinoma (RCC) were made. On immunocytochemistry, the tumor cells were synaptophysin, inhibin, vimentin and Melan-A positive but cytokeratin and epithelial membrane antigen negative. Thus, a cytodiagnosis of myxoid ACC was made and histopathologic examination was suggested. Subsequent histologic examination and immunohistochemistry proved the case to be myxoid ACC.

Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging

“…Myxoid ACC is an uncommon variant of ACC and first reported by Tang and colleagues in 1979 in a 41-year-old woman [ 140 ]. Up to the year 2020, 47 cases of myxoid ACC have been reported in the literature [ 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 ].…”

“…Macroscopically, the tumour had a yellow-brown appearance with variegated appearance like that of conventional ACC. In addition, gelatinous myxoid areas were noted [ 148 , 151 ]. Microscopically, the tumour is characterised by the cords or trabeculae of tumour cells floating in stroma with diffuse pools or lack extracellular mucin which is positive for alcian blue.…”

Ectopic Cortisol and Androgen-Producing Adrenocortical Carcinoma Arising from Adrenal Rest Tissue in a Kidney: Case Report and Literature Review

“…Immunohistochemical studies confirmed the tumor cells' steroidogenic capability as they were immunopositive for calretinin, inhibin, vimentin, melanoma antigen recognized by T cells-1, and synaptophysin (5,7). Immunohistochemical studies were also useful to differentiate the tumor from renal cell carcinoma as the tumor was immunonegative for cytokeratin and CD 10, markers that are found in renal cell carcinoma (7). In addition, the native adrenal gland was atrophic and free of the tumor which strongly supports that the malignant tumor cells arose from the adrenal rest tissue in the kidney.…”

Aldosterone‐producing adrenocortical carcinoma with myxoid differentiation in a cat

“…Primary adrenal neoplasms are rare in cats and most frequently include cortical adenomas and carcinomas, with pheochromocytomas being far less common . Adrenocortical carcinoma with myxoid differentiation is a variant of adrenocortical carcinoma rarely found in humans, ferrets, and cattle, and to our knowledge has not been reported in cats . Here we describe the clinical, cytologic, histopathologic, and immunohistochemical findings of an aldosterone‐producing adrenocortical carcinoma with myxoid differentiation in a cat.…”