title: Corticomedullary mixed tumour resembling a small adrenal gland-involvement of cancer stem cells: case report.
abstract: BACKGROUND
  Adrenal corticomedullary mixed tumours are very rare. Its mechanism is rarely reported. Here we report the first case of a corticomedullary mixed tumour resembling a "small adrenal gland" with distinct arrangement of the cortical and medullary layers. We further hypothesize regarding the tumorigenic mechanism of this tumour.
  
  
  METHODS
  A 58-year man had been diagnosed with diabetes and hypertension for 3 years. His 24-h urine vanillylmandelic acid (VMA) levels were slightly elevated. An abnormal circadian cortisol rhythm was noted, and his cortisol levels were not suppressed by dexamethasone. Abdominal computed tomography (CT) revealed a right adrenal gland lesion (diameter, 30 × 38 mm), while an enhanced CT showed enhancement and hypervascularization. The tumour was positive for adrenocorticotropic hormone, chromogranin A (CGA), and steroidogenic factor-1 (SF-1) on the tumour surface. Acetaldehyde dehydrogenase 1(ALDH1), CD44, CD133, Nestin, Nerve growth factor receptor (NGFR), and Sex determining region y-box 9(SOX9) staining were positive. Although administration of medications for diabetes and hypertension was stopped until surgery was performed, the blood sugar level and blood pressure were maintained after surgery.
  
  
  CONCLUSIONS
  This is the first report about a possible mechanism by which cancer stem cells induce adrenal corticomedullary tumours.
authors.affiliation: Department of Endocrinology, Xinqiao Hospital, Third Military Medical University, Xinqiao Street No.183, Shapingba District, Chongqing, 400037, China. jasonmao2005@163.com.
authors.forename: Lian
authors.initials: L
authors.lastname: Duan
authors.affiliation: Department of Endocrinology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
authors.affiliation: Department of Pathology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Wanlei
authors.initials: W
authors.lastname: Fu
authors.affiliation: Department of Urology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Zhenqiang
authors.initials: Z
authors.lastname: Fang
authors.affiliation: Department of Endocrinology, Xinqiao Hospital, Third Military Medical University, Xinqiao Street No.183, Shapingba District, Chongqing, 400037, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Shicang
authors.initials: S
authors.lastname: Yu
authors.affiliation: Molecular & Translational Radiation Oncology, Heidelberg Ion Therapy Center, Heidelberg Institute of Radiation Oncology, University of Heidelberg Medical School and National Center for Cancer Diseases, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Zili
authors.initials: Z
authors.lastname: Tang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Zhenqi
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Endocrinology, Xinqiao Hospital, Third Military Medical University, Xinqiao Street No.183, Shapingba District, Chongqing, 400037, China. fnf7703@hotmail.com.
authors.forename: Hongting
authors.identifier: http://orcid.org/0000-0003-4272-3461
authors.initials: H
authors.lastname: Zheng
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000378:metabolism / Q000473:pathology*; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D053379:Chromogranin A / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D014411:Neoplastic Stem Cells / Q000378:metabolism / Q000473:pathology*; D054339:Steroidogenic Factor 1 / Q000378:metabolism; D014057:Tomography, X-Ray Computed; D014642:Vanilmandelic Acid / Q000652:urine
chemical_list: D053379:Chromogranin A; D054339:Steroidogenic Factor 1; D014642:Vanilmandelic Acid; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone
keywords: Cancer stem cell; Case report; Corticomedullary mixed tumour; Tumorigenic mechanism