An unusual tumor of the adrenal gland

Adenomatoid tumors are benign mesothelial tumors that usually affect the genital tract. We report the case of a 65-year-old man with an adenomatoid tumor of the adrenal gland. This uncommon location and its histological heterogeneity can lead to a mistaken diagnosis of malignant tumor. Positive cells with mesothelial markers in immunohistochemistry improve diagnosis. The proper identification of this benign tumor in the adrenal gland and the knowledge of its differential diagnosis deserve attention to avoid invasive treatment.     

Adenomatoid tumor of the right adrenal gland: a case report

Adenomatoid tumor of adrenal gland is a very rare primary tumor with favourable prognosis. The mesothelial origin of this tumor was confirmed by multiple studies of various authors. This origin was proven by immunohistochemical and ultrastructural examinations. In our case report, we present an interesting case of the adenomatoid tumor of the right adrenal gland in a 55-year-old woman. Our case is the second well-documented case of this tumor occurring in a female adult patient. We emphasize the presence of an intraluminal thread-like bridging strands, generally considered to be a characteristic histologic feature of this tumor, which have not yet been reported in literature in adenomatoid tumor located in adrenal glands.     

Adenomatoid Tumor of the Right Adrenal Gland in a Patient with AIDS

An autopsy case with an incidentally discovered adenomatoid tumor (AT) arising in the right adrenal gland of a 34-yr-old man with AIDS is presented. The immediate cause of death was disseminated coccidioidomycosis. The affected right adrenal gland was partially substituted by a firm 3.0 cm nodule enclosed by cortical adrenal tissue. Histologically, the tumor had the typical appearance of those adenomatoid neoplasms described in the genital tract. The mesothelial origin of the neoplasm was confirmed by immunopositive cells for low weight cytokeratin and vimentin. Uncommon neoplasms in the adrenal glands of AIDS patients include leiomyosarcomas, leiomyomas, and malignant nerve sheath tumors. This report may represent the first case of an adrenal gland AT in a patient with AIDS, and probable the third well-documented histologically and immunohistochemically adrenal gland AT.     

Adenomatoid tumor of the adrenal gland.

An adenomatoid tumor of the adrenal gland is presented. The tumor was discovered in a patient with hypertension and was clinically mistaken for a pheochromocytoma. This is the first reported case, to my knowledge, of an adenomatoid tumor within the adrenal gland, with the exception of one previous article in which the lesion was mistaken for a lymphangioma. This case illustrates that adenomatoid tumors can rarely occur in extragenital locations, even in regions presumably devoid of mesothelial cells.     

Adenomatoid tumor of the testis with intratesticular growth: a case report and review of the literature

Adenomatoid tumor of the male genitourinary tract is a rare benign neoplasm thought to be of mesothelial origin. In exceptional cases, these lesions may involve the testicular parenchyma, of which there are only 9 published cases in the literature. The authors describe a rare case of a testicular tumor in a 41-year-old male with normal tumor markers. Histopathology and immunohistochemical studies revealed an adenomatoid tumor with intratesticular growth. No involvement of the epididymis or testicular membranes was identified. The morphological clues leading to the correct diagnosis of adenomatoid tumor and the possible histogenesis and differential diagnosis are discussed.     

Adenomatoid tumor of the adrenal gland with ultrastructural and immunohistochemical demonstration of a mesothelial origin

We describe an adenomatoid tumor arising in the left adrenal gland of a patient who underwent bilateral adrenalectomy for the ectopic adrenocorticotropic hormone syndrome. The mesothelial origin of the tumor was confirmed by electron microscopy and positive immunohistochemical staining for keratin. The tumor had a prominent cystic component raising the question whether adrenal cysts are derived from mesothelial inclusions. It is proposed that consideration be given to adding a new category of "mesothelial cysts" to the classification of adrenal gland cysts.     

Adenomatoid tumor of the pleura. Case report

We report a case of an adenomatoid tumor of particular location within the pleura, incidentally discovered on a pulmonary lobectomy specimen after surgical resection of a pulmonary squamous cell carcinoma. This adenomatoid tumor appeared as a unique pleural mass located away from the primary carcinoma and consisted of a cellular proliferation organised in tubes and sheets. Adenomatoid tumors are considered as benign tumors of mesothelial nature. Their morphological and immunohistochemical features in association with their location to the pleura, warrant a precise analysis to eliminate malignant tumours such as malignant mesothelioma or metastatic adenocarcinoma.     

Composite adenomatoid tumor and myelolipoma of adrenal gland: report of 2 cases

Adenomatoid tumor and myelolipoma are benign, hormonally inactive tumors that are often incidental findings in the adrenal glands. Myelolipoma is more common than adenomatoid tumor in this location but both are rare, and as yet, the pathogenesis of both remains unclear. We report 2 cases of composite adenomatoid tumor and myelolipoma, incidentally found in the adrenal gland on investigation for other diseases. To our knowledge, composite adenomatoid tumor and myelolipoma of adrenal gland has not been previously reported.     

Solitary fibrous tumor of the nasal cavity and orbit

Solitary fibrous tumors (SFT) are rare spindle cell neoplasms generally associated with the serosal surface, especially the pleura. Two SFT are reported arising in the nasal cavity and orbit, occurring in a 33 year old female and a 21 year old male, respectively. The lesions lacked the characteristic features of other recognized neoplasms that occur in these regions. Immunohistochemically, the tumors cells were diffusely and strongly positive for vimentin and CD34 and some or many tumor cells expressed neuron-speciflc enolase and Leu-7. Ultrastructurally, the tumor cells showed no distinct features although they were suggested to be primitive mesenchymal or fibroblast-like cells. Both tumors were diploid by flow cytometry. The two patients have had benign clinical courses with limited follow-up. Our findings suggest that SFT is of mesenchymal cell origin and support another location for SFT, indicating additional evidence against mesothelial origin. SFT should be included in the differential diagnosis of spindle cell tumors arising in the nasal cavity and orbit.     

Adenomatoid tumor of the adrenal gland: case report with immunohistochemical study

Adrenal adenomatoid tumor (AT) is a recently recognized disease with marked male predominance. Herein is presented a case of adrenal AT incidentally found in a 30-year-old man and results of immunohistochemical examination of the tumor. The left adrenal gland, weighing 17 g, contained a mass measuring 3 x 2.5 x 2.5 cm in the cortical tissue. Cut surface showed a relatively well-circumscribed firm tumor with a white solid appearance. Histologically, the tumor had the typical appearance of AT described in the genital tract. Immunohistochemically, the tumor cells were positive for calretinin, D2-40, WT1, mesothelial cell antigen, CA125, thrombomodulin, vimentin and cytokeratins (stained by AE1 + AE3, OV-TL 12/30, CAM5.2 and MNF116), and negative for endothelial markers (CD31, CD34 and factor VIII-related antigen) and CD56. CD56-positive adrenocortical cells were diffusely scattered in the tumor, especially in its periphery. Immunohistochemistry of estrogen, progesterone and androgen receptors was negative. These findings confirm mesothelial origin of the tumor and suggest that this tumor has little relation to sex hormone despite male predominance.     

Polycystic mesothelioma of the peritoneum. Description of 4 cases]

Cystic mesothelioma is a rare tumor of the peritoneal cavity arising from mesothelial cells. About 130 cases have been reported in the literature. The tumor is more frequent (85%) in adult women and rarely occurs in children. It is benign but recurrences are often described. The differential diagnosis with adenomatoid tumors, lymphangiomas, cystic malignant mesotheliomas and metastatic serous cystic tumors of the ovary is supported by immunohistochemistry. We describe four cases of cystic mesothelioma of the peritoneum; two of the cases occurred in pregnant women, one in a 45-year-old man and one in a 5-year-old boy. Asbestos exposure was not documented. The mesothelial origin of the neoplasms was supported by immunohistochemical analysis. Furthermore, tests for simian virus 40 (SV40 T antigen), to determine whether this virus was also present in the lesions, were negative.     

Are all adenomatoid tumors adenomatoid mesotheliomas?

The ultrastructure of three histologically typical adenomatoid tumors of the epididymis is presented. Two of the three tumors showed morphologic features of mesothelium similar to those reported in the literature. The third tumor demonstrated a multilayered basal lamina and Weibel-Palade bodies, both of which have been found consistently in sclerosing hemangiomas. Although the ultrastructure of the first two tumors confirms the theory of a mesothelial origin of adenomatoid tumors, the findings of the third tumor indicate that a histologically typical adenomatoid tumor may not necessarily be a mesothelioma and that electron microscopy is indispensable in establishing their nature. These findings also lead us to suggest that the term adenomatoid tumor should remain in use for light microscopic diagnosis, and that the term adenomatoid mesothelioma should be applied only when the mesothelial nature of an adenomatoid tumor is proven by electron microscopy. For those that show ultrastructural evidence of endothelial origin, the term adenomatoid angioma seems to be appropriate and accurate. It is possible that the adenomatoid angioma represents a variant of the histiocytoid hemangioma.     

Mesothelial lesions of the paratesticular region

Mesothelial lesions involving the paratesticular region include mesothelial cysts, reactive mesothelial hyperplasia, adenomatoid tumors, benign cystic mesothelioma, well-differentiated papillary mesothelioma, and malignant mesothelioma. The diagnosis and management of these lesions are often difficult for surgical pathologists, surgeons, and oncologists alike. Mesothelial lesions are relatively uncommon and most benign and malignant tumors present as testicular tumors with no specific findings. A preoperative diagnosis of malignancy is rarely made, and there is no established effective therapy for malignant mesothelioma. This article reviews the clinicopathologic features of paratesticular mesothelial lesions with emphasis in their differential diagnosis and prognosis.     

Multiple extragenital adenomatoid tumors in the mesocolon and omentum

Adenomatoid tumors are benign mesothelial neoplasms most commonly found in the male and female genital tracts. Extragenital adenomatoid tumors are rare, most of them being solitary tumors. To our knowledge, only one case of multiple extragenital adenomatoid tumors, involving the liver and peritoneum, has been reported to date. Here we report another case of multiple extragenital adenomatoid tumors involving the mesocolon and omentum. A 47‐year‐old woman presented with a delayed menstrual period. Ultrasonography revealed a left adnexal mass, and surgical resection was attempted at a local hospital. The patient was transferred to our hospital without resection due to the intraoperative finding of multiple peritoneal tumors. At our hospital, an 8.0×7.5×6.0 cm tumor at the mesocolon of the sigmoid colon and three omental nodules measuring up to 2.5×2.0×1.7 cm were resected. Grossly, they were well circumscribed, gray‐tan and elastic with small cystic spaces. Microscopically, they were composed of tubules and anastomosing channels lined by flattened or cuboidal cells with bland nuclei. Immunohistochemically, the tumor cells were positive for pan‐cytokeratin AE1/AE3, vimentin, cytokeratin 5/6 and calretinin. The postoperative course was uneventful, and the patient was well 10 months after the operation. Despite their rarity, adenomatoid tumors should be included in the differential diagnosis of multiple intra‐abdominal tumors.     

Multinodular-adenomatoid tumor of the uterus in a patient with a renal allograft

A case of diffuse-adenomatoid tumor of the uterus occurring in a 43-year-old patient with a renal-allograft transplant is reported. Grossly, the lesions were thought to be multiple leiomyomas. The diagnosis was supported by the adenomatoid and angiomatoid histologic patterns and the mesothelial immunophenotype. Diffuse-adenomatoid tumor of the uterus is a rare and benign lesion, usually reported in patients with immunodeficiency and renal transplant.     

True Adrenal Mesothelial Cyst in a Patient with Flank Pain and Hematuria

True mesothelial (epithelial) cysts in the adrenal gland are rare lesions. They represent 9% of adrenal cysts and are much less common than vascular adrenal cysts. We report a case of a true adrenal mesothelial cyst in a patient with flank pain and hematuria that was diagnosed on imaging as a renal cyst. Immunohistochemical studies were performed to investigate the nature of the cyst lining. The positive immunostains for calretinin and WT-1 lend support to the postulate of Medeiros et al nearly 20 years ago of a mesothelial origin for these cysts. The clinical presentation and salient radiologic and pathologic features are described.     

子宫和卵巢腺瘤样瘤的临床病理分析

目的 探讨女性生殖系统腺瘤样瘤的发生、免疫组织化学表达的特征及鉴别诊断。方法 对24例子宫和卵巢腺瘤样瘤进行临床病理及免疫组织化学观察。结果 24例患者中腺瘤样瘤发生于子宫者21例,卵巢者2例,子宫与卵巢同时发生者1例,分别占本院同期子宫及卵巢肿瘤及瘤样病变的0.34%和0.06%。免疫组织化学染色显示：波形蛋白及细胞蛋白（AE1／AE3）均为阳性,呈双相表达;第八因子相关抗原（FⅧRAg)均为阴性;S－100蛋白20例阳性（83.3%),上皮膜抗原（EMA）4例阳性（16.7%);其中10例行calretinin蛋白染色,均为阳性表达。结论 女性生殖系统腺瘤样瘤为间皮起源,子宫为最常见部位。免疫组织化学染色结果可作为诊断及鉴别诊断的重要参考依据。其生物学行为为良性,预后良好。     

ADENOMATOID TUMOR OF THE MALE GENITAL TRACT–A Pathological Study of Eight Cases and Review of the Literature–

Eight cases of adenomatoid tumors of the male genital tract are presented. Histological, histochemical, and electron microscopic studies were performed and an approach to a new classification of adenomatoid tumors was discussed. The number of so-called adenomatoid tumors of male genital tract reported in Japan adding our eight cases totalled 60 cases. These were classfled as follows; 10 cases of mesothelial (superficial) type and 50 cases of adenomatoid (profound) type. Besides these, 8 cases of mesothelial type were reported in foreign literatures. Three cases of adenomatoid tumors of the uterus and a case of epididymitis chronica with reactive proliferation of mesothelial cells were also examined. As a result of these investigations, it is suggested that the histoQenesis of the so-called adenomatoid tumors is composed of two different processes: i.e., mesothelial type arising from serosal mesothelial cells and adenomatoid type arising from immature Miillerian mesenchymal tissue.     

Immunohistochemical analysis of adenomatoid tumor of the uterine corpus--comparison with mesothelioma]

Immunohistochemical study was carried out in a case of adenomatoid tumor of the uterine corpus. The patient was a 35-year-old female. The tumor showed classical histochemical and immunohistochemical findings of mesothelioma, i.e., presence of hyaluronic acid on the cellular surface and cytokeratin in the cytoplasm. In addition, the tumor showed positive reaction to anti-vimentin. Furthermore, absence of Ber-Ep4 supports mesothelial origin of this tumor. EMA reaction was reported only in one case in the literature. The result was negative as in our case. Therefore, it was suggested that at least some of the adenomatoid tumor were negative for EMA as in malignant mesothelioma, although this tumor was benign. Therefore, it was suggested that loss of EMA in mesothelial tumor was not always related to anaplastic change.