Podium 01
腎上腺皮質腺瘤合併骨髓脂肪瘤-案例報告
李齊泰1,2*，張景欣1,2,3
陽明交通大學微免所, 臺北醫學大學附設醫院泌尿科,臺北醫學大學泌尿腎臟研究中心
adrenocortical adenoma with myelolipoma-case report
Chitai Li1,2* , Ching-Hsin Chang1,2,3
1.Department of Urology, Taipei Medical University Hospital, Taipei, 11031, Taiwan
2.TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, 11031, Taiwan
3.Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan.
Case report:
This 52-year-old male patient had a medical history marked by hypertension, hyperlipidemia, and coronary artery disease, with triple vessel disease for which he underwent stenting five years ago. Due to persistent hypertension, an adrenal profile assessment was conducted, revealing elevated plasma aldosterone levels (204.63 pg/ml) without accompanying hypokalemia. Furthermore, a 24-hour urine test disclosed an elevated level of vanillylmandelic acid (VMA) at 8.42 mg/24hr. Subsequently, he was referred to our Urology outpatient department for further evaluation. A CT scan confirmed the presence of a left adrenal tumor measuring approximately 4cm in diameter. Given the clinical suspicion of a left functional adrenal tumor, the patient underwent laparoscopic left adrenalectomy in September. He tolerated the entire procedure and was discharged smoothly after a three-day hospital stay.
The pathology report revealed an adrenocortical adenoma with areas of myelolipoma. Microscopically, the adrenal mass exhibited features of an adrenocortical adenoma composed of tumor cells with abundant foamy cytoplasm and areas of eosinophilic cytoplasm in sheet-like patterns (clear or vacuolated cells accounting for approximately 95% of the submitted tumor areas). Additionally, areas of fibrous degeneration were observed. Within the well-defined, tan to gray, and soft tumor lesion, eccentrically located within the adrenocortical adenoma, there was evidence of a myelolipoma with areas of fibrous tissue, vascular dilatations, focal calcifications, and adipose tissue. Some bone marrow elements were identifiable within the adipose tissue, consisting of myeloid elements, erythroid elements, and megakaryocytes. The myeloid, erythroid, and megakaryocyte elements displayed unremarkable topography and differentiations. A decreased myeloid-to-erythroid ratio was observed due to myeloid hypoplasia. The surgical margins were free of both megakaryocytes and adrenocortical adenoma, confirming the presence of myelolipoma.
Three months post-surgery, the patient's hypertension medication dosage remained unchanged.
It is important to note that most adrenal incidentalomas are benign adenomas that typically do not produce symptoms. Additionally, adrenal lipomatous tumors, including myelolipoma, lipoma, teratoma, angiomyolipoma, and adrenocortical tumors with lipomatous and myelolipomatous metaplasia, should also be considered in the differential diagnosis. The variable presence of fat in lipomatous tumors can sometimes lead to misdiagnosis as malignant lesions in pre-operative imaging studies.
腎上腺皮質腺瘤合併骨髓脂肪瘤-案例報告
李齊泰1,2*，張景欣1,2,3
陽明交通大學微免所, 臺北醫學大學附設醫院泌尿科,臺北醫學大學泌尿腎臟研究中心
adrenocortical adenoma with myelolipoma-case report
Chitai Li1,2* , Ching-Hsin Chang1,2,3
1.Department of Urology, Taipei Medical University Hospital, Taipei, 11031, Taiwan
2.TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, 11031, Taiwan
3.Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan.
Case report:
This 52-year-old male patient had a medical history marked by hypertension, hyperlipidemia, and coronary artery disease, with triple vessel disease for which he underwent stenting five years ago. Due to persistent hypertension, an adrenal profile assessment was conducted, revealing elevated plasma aldosterone levels (204.63 pg/ml) without accompanying hypokalemia. Furthermore, a 24-hour urine test disclosed an elevated level of vanillylmandelic acid (VMA) at 8.42 mg/24hr. Subsequently, he was referred to our Urology outpatient department for further evaluation. A CT scan confirmed the presence of a left adrenal tumor measuring approximately 4cm in diameter. Given the clinical suspicion of a left functional adrenal tumor, the patient underwent laparoscopic left adrenalectomy in September. He tolerated the entire procedure and was discharged smoothly after a three-day hospital stay.
The pathology report revealed an adrenocortical adenoma with areas of myelolipoma. Microscopically, the adrenal mass exhibited features of an adrenocortical adenoma composed of tumor cells with abundant foamy cytoplasm and areas of eosinophilic cytoplasm in sheet-like patterns (clear or vacuolated cells accounting for approximately 95% of the submitted tumor areas). Additionally, areas of fibrous degeneration were observed. Within the well-defined, tan to gray, and soft tumor lesion, eccentrically located within the adrenocortical adenoma, there was evidence of a myelolipoma with areas of fibrous tissue, vascular dilatations, focal calcifications, and adipose tissue. Some bone marrow elements were identifiable within the adipose tissue, consisting of myeloid elements, erythroid elements, and megakaryocytes. The myeloid, erythroid, and megakaryocyte elements displayed unremarkable topography and differentiations. A decreased myeloid-to-erythroid ratio was observed due to myeloid hypoplasia. The surgical margins were free of both megakaryocytes and adrenocortical adenoma, confirming the presence of myelolipoma.
Three months post-surgery, the patient's hypertension medication dosage remained unchanged.
It is important to note that most adrenal incidentalomas are benign adenomas that typically do not produce symptoms. Additionally, adrenal lipomatous tumors, including myelolipoma, lipoma, teratoma, angiomyolipoma, and adrenocortical tumors with lipomatous and myelolipomatous metaplasia, should also be considered in the differential diagnosis. The variable presence of fat in lipomatous tumors can sometimes lead to misdiagnosis as malignant lesions in pre-operative imaging studies.