林志德 劉中一 林柏宏 虞凱傑 張英勛 馮思中 莊正鏗

林口長庚紀念醫院 外科部 泌尿科

 

Chih-Te Lin, Chung-Yi Liu, Po-Hung Lin, Kai-Jie Yu, Ying-Hsu Chang, See-Tong Pang, Cheng-Keng Chuang

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan

 

Abstract: We report a rare case of xanthogranulomatous of left adrenal gland in a 55-year-old man. The patient presented to the hospital with fever, abdominal fullness, and left flank pain. His medical history was alcoholic liver cirrhosis, hypertension and diabetes mellitus. The CT in Hsinchu Mackaay Hospital revealed left adrenal heterogenous mass with 6.3cm which was considered abscess or malignance. The 18F-FDG PET revealed malignant adrenal tumor with concomitant inflammation. The biochemistry revealed normal urine VMA, plasma Renin , plasma aldosterone , plasma cortisol , plasma metanephrine and plasma normetanephrine level but mild elevated urine catecholamine-NE level. The tumor marker CA19-9 mildly elevated. After his infection subsided, the urologist was performed left nephrectomy with adrenalectomy after 3 months later. Grossly, the adrenal gland has been replaced by an uncapsulated, ill-defined, firm and gray-white tumor measuring 6.5 x 4.3 x 2.0 cm. The tumor extends to the renal sinus area and does not show renal parenchymal invasion. On histologic examination, the tissue showed adrenal gland with distorted architecture, marked fibrosis and extensive infiltration of lymphoplasmacytic cells and sheets of foamy histiocytes. Scattered lymphoid follicles or aggregates are also seen. It appears primarily to be xanthogranulomatous inflammation. Malakoplakia and Rosai-Dorfman disease will be excluded by immunostain and special stain. The kidney is not involved but has perirenal fibrosis and chronic inflammation.