title: Adrenocortical carcinoma with concomitant myelolipoma in a patient with hyperaldosteronism.
abstract: We present a case of aldosterone-secreting adrenocortical carcinoma with concomitant myelolipoma. To the best of our knowledge, this is the first such reported case. The patient was a 43-year-old man with severe hypertension. Clinical workup revealed an increased serum aldosterone level, hypokalemia, and metabolic alkalosis, and a left adrenal mass was found on computed tomography. The patient underwent a unilateral adrenalectomy, which led to improvement in blood pressure, the serum potassium level, and aldosterone concentration. The tumor weighed 70 g and measured 5.0 cm. On microscopic examination, we found necrosis, focal cytologic atypia, diffuse eosinophilic cells comprising more than 75% of the tumor, 5 to 7 mitotic figures per 50 high-power fields, rare atypical mitosis, and venous invasion. At the periphery of the tumor but within the capsule, microscopic areas of myelolipoma were seen. Ki-67 staining was positive in 20% of the tumor cells. Although rare, aldosterone-secreting carcinoma associated with myelolipoma should be included in the differential diagnosis of adrenal gland masses.
authors.affiliation: Department of Pathology, The University of Texas Medical Branch at Galveston, Houston, Tex 77555-0588, USA.
authors.forename: Xichun
authors.initials: X
authors.lastname: Sun
authors.forename: Alberto
authors.initials: A
authors.lastname: Ayala
authors.forename: Claudia Y
authors.initials: CY
authors.lastname: Castro
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D000315:Adrenalectomy; D018268:Adrenocortical Carcinoma / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D000328:Adult; D000450:Aldosterone / Q000097:blood / Q000378:metabolism; D014408:Biomarkers, Tumor; D006801:Humans; D006929:Hyperaldosteronism / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D006973:Hypertension / Q000209:etiology / Q000473:pathology; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D018209:Myelolipoma / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D009378:Neoplasms, Multiple Primary; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen; D000450:Aldosterone