Differential diagnosis of adrenal gland tumor: rare case report
Abstract
With the advent of high-resolution research methods (CT, MRI), randomly detectable formations in the adrenal glands became a clinical problem. The incidence of incidental adrenal glands varies between studies. So, according to the latest data, IN is detected in about 4-5% of patients who underwent radiological imaging. A clinical observation of a 39-year-old patient with complaints of persistent increase in blood pressure is presented. In the course of a routine ultrasound of the kidneys, the formation of a left adrenal gland was revealed. According to the data of the subsequent examination (adrenal SCT with contrast, determination of the hormonal profile), adrenocortical cancer, a glucocorticoid producing, was diagnosed. The patient underwent surgical treatment in the volume of left laparoscopic adrenalectomy. However, according to the results of a postoperative histological and immunohistochemical study, pheochromocytoma was diagnosed. The patient was discharged in satisfactory condition under the supervision of an endocrinologist and a surgeon. This clinical observation demonstrates that the “ideal” diagnostic approaches for differential diagnosis of IN have not yet been developed. Therefore, the continuation of research aimed at improving the diagnostic algorithm, which makes it possible to more accurately determine the morphological nature of education and its hormonal activity at the preoperative stage, is relevant both in scientific and in practical terms.
About the Authors
Natalia I. VolkovaRostov State Medical University
Russian Federation
MD, PhD, Professor
Liliya A. Ganenko
Rostov State Medical University
Russian Federation
MD
Vladimir Y. Mazhuhin
Rostov State Medical University
Russian Federation
MD
Aleksej N. Shevchenko
Rostov Scientific and Research Institute of Oncology
Russian Federation
MD, PhD, Professor
References
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Supplementary files
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1. Fig. 1. Patient B., purple striae of the axillary region. | |
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2. Fig. 2. Histological picture of the removed adrenal specimen (stained with hematoxylin and eosin, × 120). Discomplexed variant of pheochromocytoma. Particular attention should be paid to the uneven secretory activity of adrenal cortex cells (glomerular zone), active light zones with pronounced congestion. | |
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3. Fig. 3. Histological picture of the removed adrenal specimen (stained with hematoxylin and eosin, × 120). Malignant pheochromocytoma with moderate invasive growth in the adrenal cortex (from left to right), vessels, necrosis, and perivasal inflammatory infiltration. | |
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4. Fig. 4. Morphological description of nefrobioptatov: a - uneven increase in glomeruli in size, hypercellularity due to moderate proliferation of mesangium cells (stained with hematoxylin and eosin, × 240); b - there is marked thickening of the walls of arterial vessels with dystrophic changes of the endothelium as a sign of hypertensive angiopathy (stained with hematoxylin and eosin, × 240); c - basement membranes of capillary loops are thickened, capsules of single glomeruli are focal sclerotic; hyalinosis of individual glomeruli (stained with hematoxylin and eosin, × 240). | |
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5. Рисунок 4Б | |
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6. Рисунок 4В | |
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7. Рисунок 5 | |
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8. Fig. 5. Electron microscopy of nephrobioptat (color - silver impregnation, 1010 000). Thickening of the glomerular basement membrane, significant in places. Extensive smoothing fields of small processes of podocytes. | |
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Review
For citations:
Volkova N.I., Ganenko L.A., Mazhuhin V.Y., Shevchenko A.N. Differential diagnosis of adrenal gland tumor: rare case report. Endocrine Surgery. 2018;12(3):150-156. (In Russ.)
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