title: Mixed corticomedullary carcinoma of the adrenal gland: a case report.
abstract: OBJECTIVE
  To report the case of a 78-year-old woman with mixed corticomedullary carcinoma of the adrenal gland, and to review other reported lesions that exhibit clinical and/or histopathologic features of both adrenal cortical and medullary differentiation.
  
  
  METHODS
  We describe the patient's clinical findings and laboratory test results, as well as the gross and histopathologic features of her tumor. We also review the literature pertaining to mixed corticomedullary adenomas and cortical tumors with clinical features of pheochromocytoma, and vice versa.
  
  
  RESULTS
  A 78-year-old woman with a 10-cm left adrenal mass was hospitalized for management of hypertensive urgency. Laboratory workup revealed elevated urinary metanephrine excretion and elevated serum dehydroepiandrosterone sulfate levels. She underwent left adrenalectomy. Pathologic examination of the lesion showed mixed cortical and medullary histologic characteristics, as well as gross and microscopic evidence of malignancy. Including the present case, we identified 17 cases of neoplasms that exhibit features of mixed corticomedullary differentiation.
  
  
  CONCLUSIONS
  This report represents the first documented case of mixed corticomedullary carcinoma. Several benign lesions combine clinical, biochemical, and/or histopathologic evidence of both adrenal cortical and medullary differentiation, including mixed corticomedullary adenomas and corticotropin-secreting pheochromocytomas. The differential diagnosis of a lesion with mixed cortical and medullary features should also include a malignant neoplasm.
authors.affiliation: Department of Pathology and Cell Biology, Columbia University, New York, New York 11032, USA. att2101@columbia.edu
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Turk
authors.forename: Haider
authors.initials: H
authors.lastname: Asad
authors.forename: Joseph
authors.initials: J
authors.lastname: Trapasso
authors.forename: Gretchen
authors.initials: G
authors.lastname: Perilli
authors.forename: Virginia A
authors.initials: VA
authors.lastname: LiVolsi
mesh_terms: D000302:Adrenal Cortex / Q000473:pathology*; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D000313:Adrenal Medulla / Q000473:pathology*; D000315:Adrenalectomy; D000368:Aged; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D003937:Diagnosis, Differential; D004244:Dizziness / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology; D018193:Neoplasms, Complex and Mixed / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery