Double trouble: two cases of dual adrenal pathologies in one adrenal mass
Context: Adrenal incidentalomas (AI) represent an increasingly common problem in modern endocrine practice. The diagnostic approach to AIs can be challenging and occasionally reveals surprising features. Here we describe two rare cases of complex adrenal lesions consisting of phaeochromocytomas wi...
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| Format: | Article |
| Language: | English |
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Bioscientifica
2019-03-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Online Access: | https://edm.bioscientifica.com/view/journals/edm/2019/1/EDM18-0151.xml |
| _version_ | 1817995412178468864 |
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| author | Vasileios Chortis Christine J H May Kassiani Skordilis John Ayuk Wiebke Arlt Rachel K Crowley |
| author_facet | Vasileios Chortis Christine J H May Kassiani Skordilis John Ayuk Wiebke Arlt Rachel K Crowley |
| author_sort | Vasileios Chortis |
| collection | DOAJ |
| description | Context: Adrenal incidentalomas (AI) represent an increasingly common problem in modern endocrine practice. The
diagnostic approach to AIs can be challenging and occasionally reveals surprising features. Here we describe two rare
cases of complex adrenal lesions consisting of phaeochromocytomas with synchronous metastases from extra-adrenal primaries.
Case descriptions: Patient 1 – a 65-year-old gentleman with a newly diagnosed malignant melanoma was found to harbour an adrenal lesion with suspicious radiographic characteristics. Percutaneous adrenal biopsy was consistent with adrenocortical adenoma. After excision of the skin melanoma and regional lymphatic metastases, he was followed up without imaging. Three years later, he presented with abdominal discomfort and enlargement of his adrenal lesion, associated with high plasma metanephrines. Adrenalectomy revealed a mixed tumour consisting of a large phaeochromocytoma with an embedded melanoma metastasis in its core. Patient 2 – a 63-year-old lady with a history of NF-1-related phaeochromocytoma 20 years ago and previous breast cancer presented with a new adrenal lesion on the contralateral side. Plasma normetanephrine was markedly elevated. Elective adrenalectomy revealed an adrenal tumour
consisting of chromaffin cells intermixed with breast carcinoma cells.
Conclusions: Adrenal incidentalomas require careful evaluation to exclude metastatic disease, especially in the context of a history of previous malignancy. Adrenal biopsy provides limited and potentially misleading information. Phaeochromocytomas are highly vascularised tumours that may function as a sieve, extracting and retaining irregularly shaped cancer cells, thereby yielding adrenal masses with intriguing dual pathology. |
| first_indexed | 2024-04-14T02:05:34Z |
| format | Article |
| id | doaj.art-32fde7914e694c6c9ea9bdbff99a7bd6 |
| institution | Directory Open Access Journal |
| issn | 2052-0573 2052-0573 |
| language | English |
| last_indexed | 2024-04-14T02:05:34Z |
| publishDate | 2019-03-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism Case Reports |
| spelling | doaj.art-32fde7914e694c6c9ea9bdbff99a7bd62022-12-22T02:18:40ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732052-05732019-03-01111510.1530/EDM-18-0151Double trouble: two cases of dual adrenal pathologies in one adrenal massVasileios Chortis0Christine J H May1Kassiani Skordilis2John Ayuk3Wiebke Arlt4Rachel K Crowley5Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UKDepartment of Endocrinology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UKCentre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Cellular Pathology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UKCentre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UKInstitute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UKSt. Vincent’s University Hospital and University College Dublin, Dublin, IrelandContext: Adrenal incidentalomas (AI) represent an increasingly common problem in modern endocrine practice. The diagnostic approach to AIs can be challenging and occasionally reveals surprising features. Here we describe two rare cases of complex adrenal lesions consisting of phaeochromocytomas with synchronous metastases from extra-adrenal primaries. Case descriptions: Patient 1 – a 65-year-old gentleman with a newly diagnosed malignant melanoma was found to harbour an adrenal lesion with suspicious radiographic characteristics. Percutaneous adrenal biopsy was consistent with adrenocortical adenoma. After excision of the skin melanoma and regional lymphatic metastases, he was followed up without imaging. Three years later, he presented with abdominal discomfort and enlargement of his adrenal lesion, associated with high plasma metanephrines. Adrenalectomy revealed a mixed tumour consisting of a large phaeochromocytoma with an embedded melanoma metastasis in its core. Patient 2 – a 63-year-old lady with a history of NF-1-related phaeochromocytoma 20 years ago and previous breast cancer presented with a new adrenal lesion on the contralateral side. Plasma normetanephrine was markedly elevated. Elective adrenalectomy revealed an adrenal tumour consisting of chromaffin cells intermixed with breast carcinoma cells. Conclusions: Adrenal incidentalomas require careful evaluation to exclude metastatic disease, especially in the context of a history of previous malignancy. Adrenal biopsy provides limited and potentially misleading information. Phaeochromocytomas are highly vascularised tumours that may function as a sieve, extracting and retaining irregularly shaped cancer cells, thereby yielding adrenal masses with intriguing dual pathology.https://edm.bioscientifica.com/view/journals/edm/2019/1/EDM18-0151.xml |
| spellingShingle | Vasileios Chortis Christine J H May Kassiani Skordilis John Ayuk Wiebke Arlt Rachel K Crowley Double trouble: two cases of dual adrenal pathologies in one adrenal mass Endocrinology, Diabetes & Metabolism Case Reports |
| title | Double trouble: two cases of dual adrenal pathologies in one adrenal mass |
| title_full | Double trouble: two cases of dual adrenal pathologies in one adrenal mass |
| title_fullStr | Double trouble: two cases of dual adrenal pathologies in one adrenal mass |
| title_full_unstemmed | Double trouble: two cases of dual adrenal pathologies in one adrenal mass |
| title_short | Double trouble: two cases of dual adrenal pathologies in one adrenal mass |
| title_sort | double trouble two cases of dual adrenal pathologies in one adrenal mass |
| url | https://edm.bioscientifica.com/view/journals/edm/2019/1/EDM18-0151.xml |
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