Virilizing Adrenocortical Oncocytoma in a Child: A Case Report

Functioning adrenocortical oncocytomas are extremely rare and most reported patients are 40-60 yr of age. To our knowledge, only 2 cases of functioning adrenocortical oncocytomas have been reported in childhood. We report a case of functioning adrenocortical oncocytoma in a 14-yr-old female child presenting with virilization. She presented with deepening of the voice and excessive hair growth, and elevation of plasma testosterone and dehydroepiandrosterone sulfate. She had an adrenalectomy. The completely resected tumor composed predominantly of oncocytes without atypical mitosis and necrosis. A discussion of this case and a review of the literature on this entity are presented.     

Functioning adrenocortical oncocytoma: a case report and review of the literature

Adrenocortical oncocytoma is exceptionally rare. Most of these tumors are benign and nonfunctioning. We report a case of functioning adrenocortical oncocytoma located in the right adrenal gland in a 53-year-old woman who presented with Cushing's syndrome. The tumor was small, with exclusively oncocytic histologic features. A discussion of this case and a review of the literature on this entity is presented.     

Primary collision tumors of the kidney composed of oncocytoma and papillary renal cell carcinoma: A review

BackgroundThere are well known cases of hybrid tumors of chromophobe renal cell carcinoma (RCC) and oncocytoma in kidney, where both tumors have the same cell of origin – intercalated cell of the collecting duct. However, collision tumors composed of neoplasms originating from different cell lineages such as oncocytoma and papillary RCC are extremely rare. Herein, we made a collective literature review of reported cases of collision tumors composed of oncocytoma and papillary RCC, adding a case that we recently experienced.Material and methodsA PubMed database was search for collision tumors of the kidney composed of oncocytoma and papillary RCC and a collective literature review was made. To this cohort, we also added a recently encountered case with similar, confirmed by immunohistochemistry, morphological features.ResultsTo date 8 cases of a collision tumor composed of papillary RCC and oncocytoma have been described in the literature. All of them had a smaller papillary RCC component present within a larger oncocytoma.ConclusionBecause of a few cases of such a collision tumors reported, it is difficult to make classification and right clinical management of these patients. None of the reported cases had tumor recurrence or progression on a follow-up. The presence of only small portion of papillary RCC in a large oncocytoma raises a possibility of under-sampling of malignant component in large oncocytomas in core biopsy or surgically resected specimens. We recommend better sampling, particularly at the periphery of otherwise classic oncocytomas to unveil this possible association.     

An ultrastructural study of oncocytoma and oncocytic carcinoma of the parotid gland

One case of oncocytoma and another of oncocytic carcinoma of the parotid gland are reported with ultrastructural studies. The incidence of oncocytoma varies from 0.1% to 1.4% of all parotid gland tumors, while oncocytic carcinoma is extremely rate. The oncocytoma was composed of polyhedral cells with fine eosinophilic granular cytoplasm and a rounded nucleus. The tumor cell clusters were surrounded by basement membrane. The tumor cells of the oncocytic carcinoma were also characterized by eosinophilic cytoplasm, but cellular atypia and mitotic figures were found. Electron microscopically, the cytoplasm of the oncocytoma was packed with abundant mitochondria. They were oval or elongated in shape with stacked cristae. Although the tumor cells of the oncocytic carcinoma also contained many mitochondria, their number was less than that of the benign case, and stacked cristae were very few. Basement membrane was not seen. The ultrastructural characteristics of oncocytoma and oncocytic carcinoma of the parotid gland are discussed with reference to previous reports.     

Mucin-producing renal oncocytoma. An undescribed variant of oncocytoma

We report here one case of renal oncocytoma producing focal extracellular mucinous secretion in a 47-year-old woman. To the best of our knowledge, the presence of mucinous secretion in this tumor has not yet been reported. Mucin production, despite its low frequency, can be considered an additional feature of renal oncocytoma. Therefore, oncocytoma should be added to the list of parenchymal renal tumors that can show significant mucin secretion, and it should be included in the inventory of morphologic variations of oncocytoma which may cause diagnostic difficulties.     

Small-cell variant of renal oncocytoma

Renal oncocytoma is a distinct benign tumor accounting for approximately 3-5% of all renal tumors. This neoplasm is easily recognizable in its classic form: there are polygonal cells with abundant granular eosinophilic cytoplasm filled with mitochondria. The tumor cells are arranged in nests and tubular pattern. Here, 1 case of renal oncocytoma with a domination of small cells is reported (the so-called "oncoblasts") arising in elderly woman. These small cells have scant cytoplasm, dense hyperchromatic nuclei, and a high nuclear/cytoplasmic ratio. The term "small-cell variant of renal oncocytoma" was proposed for these cases. The unusual extensive small-cell component of the tumor may represent a potential diagnostic pitfall for primary or metastatic malignant small cell tumors.     

Oncocytic glomus tumour: a new variant

A new variant of glomus tumour characterized by oncocytic change is reported. The light and electron microscopy and immunohistological findings are described. This is the first reported case of an oncocytoma of non-epithelial origin.     

Case Report: Adrenal Oncocytoma Associated with Markedly Increased FDG Uptake and Immunohistochemically Positive for GLUT1

Usually, benign tumors are not associated with an increased F-18 fluorodeoxyglucose (F-18 FDG) uptake on positron emission tomography (PET), although some exceptions have been reported in adrenal neoplasms. We present a rare case of adrenocortical oncocytoma associated with markedly increased FDG uptake, demonstrating a maximum standardized uptake value of 46.8. Histological examination demonstrated diffuse proliferation of tumor cells with eosinophilic and granular cytoplasm that were diffusely immunopositive for mitochondria and glucose transport protein 1, with focal and weak immunopositivity for 3β-hydroxysteroid dehydrogenase. Ultrastructural examination also revealed abundant mitochondria in the tumor cells. The tumor was diagnosed as adrenocortical oncocytoma and was considered benign according to Lin-Weiss-Bisceglia criteria. Diagnosis of adrenocortical oncocytoma can pose difficulties during both preoperative radiological and postoperative histopathological investigations.     

Benign oncocytic endocrine tumor of the pancreas in a patient with polyarteritis nodosa

An 8-cm mass in the tail of the pancreas was resected from a 40-year-old man with polyarteritis nodosa. The tumor cells contained abundant, finely granular, eosinophilic cytoplasm arranged in a gyriform pattern that suggested the tumor was an oncocytoma of the endocrine pancreas. Electron microscopy confirmed that the tumor was an oncocytoma by demonstrating tumor cell cytoplasm packed with mitochondria. Ultrastructural and immunocytochemical studies confirmed the neuroendocrine nature of the tumor by demonstrating dense-core, membrane-bound structures consistent with neurosecretory granules and neuron-specific enolase immunoreactivity. No immunoreactivity for insulin, glucagon, gastrin, somatostatin, or pancreatic polypeptide was found. No human chorionic gonadotropin alpha-chain immunoreactivity was detected. The patient is well without evidence of tumor five years after operation. The apparently benign behavior of the pancreatic endocrine oncocytoma reported here is in contrast to the malignant nature of another case reported recently.     

A case of liver metastasis from an oncocytoma with a focal area of chromophobe renal cell carcinoma: a wolf in sheep's clothing

In 2004, the World Health Organization classified the renal oncocytomas as benign neoplasms of the kidney. There are reports of subtypes of renal tumors, with similar histological morphology to oncocytoma, but with malignant potential, one of these tumors is the eosinophilic variant of chromophobe renal cell carcinoma. It is important to characterize the histological features and the subtype of tumor, as this predicts biological behavior and cancer-specific survival rate. A rare case of a liver metastasis from a focal area of eosinophilic variant of chromophobe renal cell carcinoma mixed in oncocytoma in a 69-year-old woman is reported. Although some renal tumors may contain oncocytoma and eosinophilic variant of chromophobe renal cell carcinoma histology, caution should be exercised while diagnosing oncocytomas in needle biopsies as there may be unsampled area of chromophobe carcinoma which has a potential for metastatic spread representing a wolf in sheep's clothing.     

Distribution of cytokeratins,vimentin and desmoplakins in normal renal tissue,renal cell carcinomas and oncocytoma as revealed by immunofluorescence microscopy

Summary Forty-two renal cell carcinomas, one oncocytoma and normal renal tissue were studied for the presence of cytokeratins and vimentin. The investigations were performed by immunofluorescence microscopy applying a panel of mono- and polyclonal antibodies to intermediate filament proteins. In all tumours except chromophobic renal cell carcinoma (CRCC) and oncocytoma a co-expression of cytokeratins and vimentin could be shown. The intermediate filament expression was often, however, very heterogeneous particularly with respect to the distribution of cytokeratins and vimentin, to the clonality of the antibodies used and to the tumour areas studied. The latter could be impressively demonstrated by examining a whole tumour. In CRCC and oncocytoma all tumour cells expressed cytokeratins and, in addition, single tumour cells also expressed vimentin. In normal renal tissue we could show vimentin-positive epithelia of proximal and distal tubules, which is reported for the first time.     

The histology and growth kinetics of canine renal oncocytoma

A renal oncocytoma was diagnosed in a 10-year-old English springer spaniel with a 5-month history of anorexia, vomiting and weight loss. The tumour, which was localized to the kidney, was treated by simple nephrectomy and the dog made a full recovery. Histologically, the tumour consisted of cells with abundant eosinophilic cytoplasm forming acini and alveolar nests set within a loose fibrovascular stroma. The results of cell kinetic studies (AgNOR score 2.68, PCNA index 5.2%) were comparable with findings reported for benign human renal tumours. This appears to be the first reported case of renal oncocytoma in a dog.     

Onkozytom der Niere mit Metastase eines Mammakarzinoms

The case of a renal oncocytoma involvement by metastasis from breast carcinoma in a 83-year-old woman is reported. The literature of tumour-into-tumour metastasis is reviewed. In conclusion, metastasis of breast carcinoma to a benign renal tumour is very rare.     

Oncocytic carcinoid of the nasal cavity and carcinoid of the lung in a child

A 13-year-old girl with an oncocytic carcinoid of the nasal cavity and a bronchial carcinoid of classical type appearing one year later is reported. This investigation includes clinicopathological features, light and electron microscopic studies and immunohistochemical analysis of neuron-specific enolase (NSE) of both tumors as well as an enzyme histochemical analysis of the nasal tumor. Based on the light microscopic appearance and ultrastructural and enzyme histochemical findings, the nasal tumor was primarily diagnosed as an oncocytoma, but due to the finding of neurosecretory granules and positivity for NSE in tumor cells, we believe it should be regarded as an oncocytic carcinoid. To our knowledge, this is the first case reported in literature of a carcinoid in the nose of a child and also the first case of simultaneous carcinoids in the bronchi and nasal cavity. The relationship between the nasal and the bronchial tumors, their origin from foregut-derived respiratory mucosa and their probable multicentric origin as opposed to metastatic origin is discussed. Furthermore, the criteria stipulated for the diagnosis of a true oncocytoma and oncocytic carcinoids are briefly discussed.     

Papillary renal cell carcinoma within a renal oncocytoma: case report of an incidental finding of a tumour within a tumour

The most common renal tumours are clear cell, papillary, chromophobe and collecting duct renal cell carcinomas (RCCs), and benign oncocytomas and angiomyolipomas. Tumours with hybrid features between some of these entities have been recognised; in particular, tumours with features of both chromophobe RCC and oncocytoma. Case reports describing one distinct type of primary renal tumour actually within another are very rare. The incidental finding of a papillary RCC located in an oncocytoma in a nephrectomy specimen from a 75-year-old man is described. Morphological criteria for each tumour type were completely satisfied and fluorescence in situ hybridisation detected the expected number of copies of chromosome 7 in the cells of each tumour type. The cells in the papillary tumour contained three copies, whereas the oncocytoma cells contained only two per nucleus. To our knowledge, this is the first report of a papillary RCC being identified within an oncocytoma.     

33-year follow-up after simple excision of a giant renal oncocytoma with calcifications: case report and review of the literature.

Renal oncocytoma can present with calcification seen on the plain roentgenogram. From a review of the literature (both before and after 1976, when the concept of oncocytoma was popularized in the English literature), 10 cases of calcification in association with renal oncocytoma were found. In three of these 10 cases, the calcifications could be grossly demonstrated on the plain roentgenogram; in the other seven cases, the calcifications were microscopic in nature. The presence of calcification in a renal tumor does not rule out the diagnosis of oncocytoma. Grossly, a renal oncocytoma has a brownish mahogany color. A case is presented in which simple excision of an oncocytoma resulted in a 33-year survival. In the future, excision instead of nephrectomy could become the standard treatment for these tumors.     

Adrenocortical oncocytoma.

The histopathology and ultrastructural features of an adrenocortical oncocytoma are reported. The tumour was discovered incidentally during investigation for hypertension in a 72 year old female. Oncocytic tumours of the adrenal cortex are rare, with only 20 examples described in English language reports. Most have been non-functioning and benign, like the present example. Molecular studies may help assess the significance of oncocytic change in the pathogenesis and behaviour of oncocytic neoplasms.     

Immunohistochemical application of S100A1 in renal oncocytoma, oncocytic papillary renal cell carcinoma, and two variants of chromophobe renal cell carcinoma

S100A1 is a calcium-binding protein and a member of the S100 family. Recently, S100A1 immunohistochemistry may be an available marker in the differential diagnosis between renal oncocytoma and chromophobe renal cell carcinoma (RCC). However, there are no reports on S100A1 expression in oncocytic papillary RCC that has been recently identified. In this article, we immunohistochemically examined the expression of S100A1 protein in 18 renal tumors including 4 renal oncocytoma, 10 chromophobe RCCs, and 4 oncocytic papillary RCCs. All the cases of renal oncocytoma and oncocytic papillary RCC showed a positive reaction for S100A1 with cytoplasmic pattern. In chromophobe RCC, 3 of 4 tumors with typical variant and 4 of 6 tumors in eosinophilic variant were completely negative for S100A1. Finally, S100A1 immunohistochemistry may be useful in distinguishing renal oncocytoma from chromophobe RCC, but it may be of no use in the differential diagnosis between renal oncocytoma and oncocytic papillary RCC.     

Oncocytoma of the stomach: a case report

An example of an oncocytoma in the wall of the stomach is reported. The diagnosis was made following ultrastructural studies and must be considered in the differential diagnosis of gastric tumours and especially of atypical leiomyomas and granular cell tumours.     

19例肾腺瘤的组织病理学观察

目的 探讨各型肾腺瘤的形态特点及其诊断标准。方法 各型肾腺瘤共19例,进行光镜,电镜观察,组织化学,免疫组织化学LSAB法检测及随访观察。结果 乳头状腺瘤3例,呈乳头,管乳头状排列;由嗜碱性细胞或嗜酸性细胞组成;上皮膜抗原（EMA）及细胞角蛋白（CK）7双表达。嗜酸细胞腺瘤13例,呈巢状排列,也见管状,乳头结构或单个细胞散在;以嗜酸细胞为主,尚见“嗜酸母细胞”及透亮细胞等;波形蛋白,CK7均阴性,Hale胶体铁染爸阴性;电镜示胞质内多量大线粒体。后肾腺瘤3例,均匀一致的小细胞构成小管,亦见实性,肾小球样,分支长管结构,间质未肿状;EMA阴性,CK7阴性或局灶阳性。各型肾腺瘤均随访3－5年,1例嗜酸细胞腺瘤5年后死亡,余均健在。结论 肾腺瘤有3种,乳头状腺瘤,嗜酸细胞腺瘤,后肾腺瘤,各有其临床病理特点,后两者以形态学为诊断依据,前者仍需参考肿瘤大小。组织化学,免疫组织化学检测有助于鉴别诊断。