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Presented by Jonathan Epstein, M.D. and prepared by Angelique W. Levi, M.D.
Case 2: 38 year old female with a 17 cm (1070 gram adrenal mass)
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Question 1 of 1
1. Question
Week 9: Case 2
38 year old female with a 17 cm (1070 gram adrenal mass)
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Answer:
Histology: The lesion is a pink cell tumor with diffuse sheets of cells with abundant eosinophilic cytoplasm. Some morphology ranges from uniform bland cells with small round nuclei to cells with marked pleomorphism. Mitotic figures including atypical ones are readily identifiable. There is necrosis identified. The large size, extensive pleomorphism, necrosis and atypical mitotic figures are all diagnostic of adrenal cortical carcinoma.
Discussion: The distinction of adrenal cortical adenoma and adrenal cortical carcinoma and pheochromocytoma is described above in case 1. Metastatic carcinoma to the adrenal is not uncommon especially from the lung. In this case, the cellular morphology closely resembles adrenal cortical cells, such that adrenal cortical carcinoma is favored over melanoma. Adrenal cortical carcinomas are positive for vimentin and variably positive for keratin, which could also rule out melanoma.
Incorrect
Answer:
Histology: The lesion is a pink cell tumor with diffuse sheets of cells with abundant eosinophilic cytoplasm. Some morphology ranges from uniform bland cells with small round nuclei to cells with marked pleomorphism. Mitotic figures including atypical ones are readily identifiable. There is necrosis identified. The large size, extensive pleomorphism, necrosis and atypical mitotic figures are all diagnostic of adrenal cortical carcinoma.
Discussion: The distinction of adrenal cortical adenoma and adrenal cortical carcinoma and pheochromocytoma is described above in case 1. Metastatic carcinoma to the adrenal is not uncommon especially from the lung. In this case, the cellular morphology closely resembles adrenal cortical cells, such that adrenal cortical carcinoma is favored over melanoma. Adrenal cortical carcinomas are positive for vimentin and variably positive for keratin, which could also rule out melanoma.
