Incidental ectopic adrenal cortical tissue: Retrospective analysis of 16 patients

Kilinç, Ayşe Nur Uğur; Kerimoğlu, Özlem Seçilmiş; Ünlü, Yaşar; Keçeli, Avni Merter; Dönmez, Muhammet İrfan

doi:10.1016/j.jpurol.2020.12.027

Cited by 3 publications

(3 citation statements)

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“…Adrenal cortical rests are characterized by small subcentimeter, isolated, yellow nodules in the fibrofatty tissue surrounding normal components at the individual location [ 22 – 24 , 52 , 53 ]. Histologically, aggregates of large eosinophilic or clear cells, with no or bland atypia resembling orthotopic adrenal cortical cell populations are observed (Fig.…”

Section: Question 2: Why Do Pathologists Need To Know Ectopic or Hete...mentioning

confidence: 99%

Overview of the 2022 WHO Classification of Adrenal Cortical Tumors

et al. 2022

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The new WHO classification of adrenal cortical proliferations reflects translational advances in the fields of endocrine pathology, oncology and molecular biology. By adopting a question–answer framework, this review highlights advances in knowledge of histological features, ancillary studies, and associated genetic findings that increase the understanding of the adrenal cortex pathologies that are now reflected in the 2022 WHO classification. The pathological correlates of adrenal cortical proliferations include diffuse adrenal cortical hyperplasia, adrenal cortical nodular disease, adrenal cortical adenomas and adrenal cortical carcinomas. Understanding germline susceptibility and the clonal-neoplastic nature of individual adrenal cortical nodules in primary bilateral macronodular adrenal cortical disease, and recognition of the clonal-neoplastic nature of incidentally discovered non-functional subcentimeter benign adrenal cortical nodules has led to redefining the spectrum of adrenal cortical nodular disease. As a consequence, the most significant nomenclature change in the field of adrenal cortical pathology involves the refined classification of adrenal cortical nodular disease which now includes (a) sporadic nodular adrenocortical disease, (b) bilateral micronodular adrenal cortical disease, and (c) bilateral macronodular adrenal cortical disease (formerly known primary bilateral macronodular adrenal cortical hyperplasia). This group of clinicopathological entities are reflected in functional adrenal cortical pathologies. Aldosterone producing cortical lesions can be unifocal or multifocal, and may be bilateral with no imaging-detected nodule(s). Furthermore, not all grossly or radiologically identified adrenal cortical lesions may be the source of aldosterone excess. For this reason, the new WHO classification endorses the nomenclature of the HISTALDO classification which uses CYP11B2 immunohistochemistry to identify functional sites of aldosterone production to help predict the risk of bilateral disease in primary aldosteronism. Adrenal cortical carcinomas are subtyped based on their morphological features to include conventional, oncocytic, myxoid, and sarcomatoid subtypes. Although the classic histopathologic criteria for diagnosing adrenal cortical carcinomas have not changed, the 2022 WHO classification underscores the diagnostic and prognostic impact of angioinvasion (vascular invasion) in these tumors. Microscopic angioinvasion is defined as tumor cells invading through a vessel wall and forming a thrombus/fibrin-tumor complex or intravascular tumor cells admixed with platelet thrombus/fibrin. In addition to well-established Weiss and modified Weiss scoring systems, the new WHO classification also expands on the use of other multiparameter diagnostic algorithms (reticulin algorithm, Lin–Weiss–Bisceglia system, and Helsinki scoring system) to assist the workup of adrenal cortical neoplasms in adults. Accordingly, conventional carcinomas can be assessed using all multiparameter diagnostic scheme...

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Section: Question 2: Why Do Pathologists Need To Know Ectopic or Hete...mentioning

confidence: 99%

Overview of the 2022 WHO Classification of Adrenal Cortical Tumors

et al. 2022

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“…Ectopic ACC in the lungs has not been previously reported. Representative ectopic adrenal tissues and neoplasms are located in anatomical organs, such as the urethral tract ( 23 ), kidney ( 9 ), ovary ( 10 ), abdominal wall ( 6 ), liver ( 20 ), retroperitoneum ( 11 , 12 ), gastric wall ( 19 ), spinal canal ( 8 ), thorax ( 24 ), and lung ( 25 ). Although ectopic adrenocortical tissues and neoplasms may also be present at any anatomical location, they rarely originate in the lungs.…”

Section: Discussionmentioning

confidence: 99%

“…In ectopic remnants of adrenal tissues, cortical tissues are usually seen alone, and medullary tissues are seen rarely. They are usually found incidentally during surgeries or autopsies ( 23 , 24 ). Ectopic adrenal tissues may develop hyperplasia, adenoma, or carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Nonfunctional ectopic adrenocortical carcinoma in the lung: A case report and literature review

et al. 2023

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BackgroundEctopic adrenocortical tissues and neoplasms are rare and usually found in the genitourinary system and abdominal cavity. The thorax is an extremely rare ectopic site. Here, we report the first case of nonfunctional ectopic adrenocortical carcinoma (ACC) in the lung.Case presentationA 71-year-old Chinese man presented with vague left-sided chest pain and irritable cough for 1 month. Thoracic computed tomography revealed a heterogeneously enhancing 5.3 × 5.8 × 6.0-cm solitary mass in the left lung. Radiological findings suggested a benign tumor. The tumor was surgically excised upon detection. Histopathological examination using hematoxylin and eosin staining showed that the cytoplasm of the tumor cells was rich and eosinophilic. Immunohistochemical profiles (inhibin-a+, melan-A+, Syn+) indicated that the tumor had an adrenocortical origin. The patient showed no symptoms of hormonal hypersecretion. The final pathological diagnosis was non-functional ectopic ACC. The patient was disease-free for 22 months and is still under follow-up.ConclusionsNonfunctional ectopic ACC in the lung is an extremely rare neoplasm that can be easily misdiagnosed as primary lung cancer or lung metastasis, both preoperatively and on postoperative pathological examination. This report may provide clues to clinicians and pathologists regarding the diagnosis and treatment of nonfunctional ectopic ACC.

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