A rare entity of an unusual site: adenomatoid tumour of the adrenal gland: a case report and review of the literature

Abstract

This is a case report of a 51 year old male who was found to have an incidental left sided non-functioning adrenal mass on routine medical examination and which was confirmed by CT and MRI scans. A laparoscopic left adrenalectomy was done. On gross examination the tumour was a solitary well circumscribed solid-cystic mass with a homogenous pinkish white cut surface. On microscopic examination, the tumour was composed of variably sized tubules and fenestrated channels lined by bland cuboidal cells to epithelioid cells. There was focal extension to capsule and peri-adrenal fat. Immunohistochemically the tumour cells stained with calretinin, Cam5.2, CK7, vimentin and focally with EMA. Ki-67 fraction was <1%. They were negative for ER, CD31, CD34, Factor 8, chromogranin, synaptophysin S100 and inhibin. A diagnosis of an adenomatoid tumour as made. Adenomatoid tumours are rare benign tumours of mesothelial derivation. The adrenal gland is devoid of a mesothelial lining and the most accepted hypothesis for an adenomatoid tumour originating in the adrenal gland is derivation from mesothelial rests. As the adrenal gland is an extremely rare site of occurrence for an adenomatoid tumour, it is frequently mistaken for adrenocortical tumours or a pheochromocytoma clinically and radiologically.

Figure 1

On macroscopy, the tumour has a homogenous solid white cut surface and is associated with a cystic component.

Figure 2

Hematoxylin & eosin (H&E) and Immunohistochemical staining of tumour within adrenal gland. (a) and (b) H&E staining: residual adrenal parenchyma is present in (a) (arrows). (c) Calretinin antibody staining (Leica Microsystems, UK, dilution 1 : 200). (d) Cytokeratin 7 antibody staining (Leica Microsystems, UK, dilution 1 : 100). (e) Ki67 antibody staining (Leica Microsystems, UK, dilution 1 : 50). (f) Inhibin antibody staining (Serotec, UK, dilution 1 : 10).