Endocrine Abstracts

JOINT551

Introduction: Adenomatoid tumor and myelolipoma are benign, hormonally inactive neoplasms of mesothelial origin, usually occurring in the male and female genital tracts. Rare extragenital adenomatoid tumors have been identified in the adrenal glands, heart, mesentery, pleura, and lymph nodes. That are often incidental findings in the adrenal glands. Myelolipoma is more common than adenomatoid tumor in this location but both are rare, yet the pathogenesis of both remains unclear

Case report: A 32 years old female gives a history of dragging left loin pain occurring in attacks for 2 years Examination revealed: Bp: 140/95, pulse: 84/Minute, Weight: 83 kgs Examination was normal apart from Left suprapubic anterior abdominal swelling about 2 to 3 cms with minimal tenderness Triphasic CT showed: A well circumscribed oval shaped right side hepatorenal pouch hypodense cystic lesion is seen insepraple from right adrenal gland is noted measuring 5.1*2.6 cms & indenting the liver surface. Mild hepatomegaly. A fairly defined isodense lesion is noted at the left semilunar is being inseparable from left lateral aspect of the left rectus muscle measuring 2.3*2.2 cms.A left adnexal cyst is noted measuring 4.8*4.8 cms. MRI of the abdomen for further evaluation of the adrenal mass showed: Right adrenal multiloculated cystic lesion is seen measuring 2.5*4.5*5 cms, eliciting high T2 & low T1 signal with marginal septal postcontast enhacement yet no diffusion restriction. She was referred for the investigation of incidental adrenal mass. Serum cortisol and adrenaline metabolites were normalResults of serum Cortisol am: 16.7 (5-25 mg/dl), ACTH am: 21.4(10-60 pg/dl) Cortisol pm: 5.2(3-10 mg/dl), Plasma renin: 12.68 (0.7-3.3 pg/dl), Aldosterone: <3.7 (<15 ng/dl)Plasma metanephrin: less than 14.9 (0.5 pg/dl), Plasma normetanephrin: 82 (<0.9 pg/dl)Urine metanephrin: 52(24-96 mg/24 hs), Urine normetanephrin: 88(75-375 mg/24 hs)The patient underwent surgery and removed both the adrenal swelling and the anterior abdominal wall swelling. The postsurgical recovery was uneventful. Microscopic examination revealed Right adrenal mass: adenomatoid tumor associated with myelolipoma. Free resection margins. Anterior abdominal swelling: endometriosis. No malignancy.

Conclusion: We report a rare case of primary Adenomatoid Tumor and Myelolipoma of Adrenal Gland treated with complete surgical resection of the tumor. A meticulous assessment of histological features pose a diagnostic challenge will aid in an accurate and effective diagnosis\. The differential diagnosis includes adrenocortical carcinoma and metastatic carcinoma, especially signet ring cell carcinoma.