A rare case of synchronous adrenocortical carcinoma and renal cell carcinoma

Abstract

We present here a rare case of synchronous adrenocortical carcinoma (ACC) and renal cell carcinoma (RCC). A 27-year-old woman presented with gradual abdominal distension, hematuria, and loss of weight of 3-months duration. She gave a history of treatment for hypertension. The computed axial tomography (CT) scan revealed a large retroperitoneal mass. Her urinary VMA was slightly elevated. Her 24-h urinary metanephrine level was normal. The patient underwent left adrenalectomy, left nephrectomy, spleenectomy, and distal pancreactomy with segmental colonic resection. Postoperative pathology revealed ACC of left suprarenal measuring 22 × 19 × 18 cm(3) and RCC involving the left upper pole of kidney measuring 3 × 2 × 1 cm(3).

Keywords: Adrenalectomy; adrenocortical carcinoma; renal cell carcinoma.

Figure 1

Adrenocortical carcinoma (H and E): (a) Pleomorphic tumor cells showing bizarre hyperchromatic nuclei (×40). (b) Sheet of pleomorphic tumor cells showing necrosis at the top (×40), (c) Mitotic activity by tumor cells (×100), and (d) tumor shows vascular invasion, marked as VI (×20)

Figure 2

Adrenocortical carcinoma (immunehistochemistry). Tumor cells showing positive reaction for (a) Inhibin (×40), (b) Ki 67 (×40), (c) C-Kit (×40), (d) Melan A (×40)

Figure 3

Renal cell carcinoma (H and E). (a) Large tumor cells with mostly clear cytoplasm are seen. Renal capsule and few renal tubules are seen at the periphery (H and E, ×10). (b) Large pleomorphic tumor cells both with clear cytoplasm and eosinophilic granular cytoplasm (H and E, ×40). (c) Pleomorphic tumor cells showing positivity for Keratin (IHC, ×40) and (d) Tumor cells showing positivity for EMA (IHC, ×40).