Case Report: A Virilizing Adrenal Oncocytoma

Abstract

A 64-year-old female was admitted to our clinic with a 9-cm-sized adrenal mass. The patient's main symptom was hirsutism, which included thinning scalp hair and excessive hair growth over her torso and arms. Upon investigation, elevated values of testosterone, androsterone D4, and DHEA-S were found. Contrast-enhanced abdominal CT and MRI scans revealed a heterogenous large mass (diameter 9 × 8.5 cm) with focal calcifications, necrotic areas, and a clear distinction from the adjacent structures. The patient underwent a right adrenalectomy. The histological examination of the tumor revealed a borderline adrenocortical oncocytoma. The patient had an uncomplicated postoperative course and was discharged on postoperative day 8. Similar cases reported in the literature are also being reviewed in this case report.

Keywords: adrenal mass; borderline; masculinization; oncocytoma; testosterone; virilization.

Figure 1

A contrast-enhanced abdominal CT scan showing a quite large heterogenous mass with focal calcifications (A) ~9 cm in size. The lesion had not only arterial (B) but also venous enhancement, while some areas remained nonenhanced, possibly necrotic (C).

Figure 2

An abdominal MRI scan was performed, and it showed the right adrenal gland lesion. It also showed a clear distinction between the lesion and adjacent structures, without any infiltration to the inferior vena cava, or presence of pathological lymph nodes, nor were there any pathological lesions or enhancement in the liver. A sagittal T2 view (a), a coronal T2 view (b), and a transverse T1 view (c).

Figure 3

The histological examination of the tumor revealed a borderline adrenocortical oncocytoma. Macroscopically, the tumor was a descriptive almost circular lesion, surrounded by a fibrous capsule. Its size was 9.4 × 8.5 × 7.3 cm, and it weighted 113 g. Microscopically, there were large round eosinophilic cells (oncocytes) with dense granular cytoplasm; nuclei were round and regular with even chromatin; small but conspicuous nucleoli were present (a, H&EX40). Immunohistochemical tests revealed that the tumor cells were positive for vimentin (b, ×40), CD56, Melan A, S-100, and synaptophysin. Oncocytoma-compact nested architecture, uniform round nuclei, and abundant pink cytoplasm (c, H&E ×40).