title: Virilizing oncocytic adrenocortical carcinoma: clinical and immunohistochemical studies.
abstract: BACKGROUND
  Oncocytic tumors of the adrenal cortex are rare, mostly nonfunctioning and benign.
  
  
  METHODS
  Report virilizing oncocytic adrenocortical carcinoma in a 50-year-old woman.
  
  
  METHODS
  She presented a recent and progressive virilization syndrome, associated with high blood pressure. Hormonal evaluation showed elevated serum testosterone and delta-4-androstenedione levels, normal urinary free cortisol level and incomplete suppression of cortisol at the 1 mg dexamethasone suppression test. CT scan of the abdomen revealed a 35 mm left adrenal mass.
  
  
  METHODS
  The patient underwent a left adrenalectomy, and the histological study showed a 3 cm oncocytic adrenocortical carcinoma with signs of malignancy.
  
  
  RESULTS
  Immunohistochemical study revealed that tumor cells expressed the steroidogenic enzymes involved into androgen synthesis (3βHSD and P450c17α), P450 aromatase and luteinizing hormone (LH) receptors. Post-operatively, signs of virilization improved rapidly, serum testosterone and delta-4-androstenedione levels returned to normal, as did the dexamethasone suppression test. During follow-up CT-scan and 18-FDG PET/CT showed a right ovary mass, corresponding to a follicular cyst associated with hyperthecosis. The patient is alive with no recurrence 48 months after adrenal surgery.
  
  
  CONCLUSIONS
  Oncocytic adrenocortical carcinomas, although extremely rare, should be considered in women with a virilization syndrome. In this woman immunohistochimical studies revealed the presence of steroidogenic enzymes involved into androgen synthesis and aromatization, and LH receptors could be implicated in this pathology.
authors.affiliation: a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France.
authors.forename: Julie
authors.initials: J
authors.lastname: Carré
authors.affiliation: a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France.
authors.forename: Solange
authors.initials: S
authors.lastname: Grunenwald
authors.affiliation: a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Vezzosi
authors.affiliation: b Department of Pathology , IUCT-Oncopole , Toulouse , France , and.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mazerolles
authors.affiliation: a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Bennet
authors.affiliation: c INSERM UMR 788 , Bicêtre , France.
authors.forename: Geri
authors.initials: G
authors.lastname: Meduri
authors.affiliation: a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Caron
mesh_terms: D018249:Adenoma, Oxyphilic / Q000150:complications* / Q000201:enzymology / Q000601:surgery; D000306:Adrenal Cortex Neoplasms / Q000150:complications* / Q000201:enzymology / Q000601:surgery; D018268:Adrenocortical Carcinoma / Q000150:complications* / Q000201:enzymology / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D014770:Virilism / Q000201:enzymology / Q000209:etiology* / Q000601:surgery
keywords: Immunohistochemistry; luteinizing hormone receptors; oncocytic adrenocortical carcinoma; steroidogenic enzymes; virilization