Insights into Clinical Features and Outcomes of Adrenal Cortical Carcinosarcoma
Adrenal cortical carcinosarcomas are a rare and typically aggressive malignancy with few reported cases in medical literature. We present a case of a 78-year-old female who presented with complaints of fatigue and right shoulder pain. Imaging of the abdomen with computed tomography visualized a larg...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-10-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/10/2419 |
| _version_ | 1827650687534628864 |
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| author | Zachery Branham Ashley D. Fox Asad Ullah Nikhil G. Patel Martha Terris Jigarkumar Parikh |
| author_facet | Zachery Branham Ashley D. Fox Asad Ullah Nikhil G. Patel Martha Terris Jigarkumar Parikh |
| author_sort | Zachery Branham |
| collection | DOAJ |
| description | Adrenal cortical carcinosarcomas are a rare and typically aggressive malignancy with few reported cases in medical literature. We present a case of a 78-year-old female who presented with complaints of fatigue and right shoulder pain. Imaging of the abdomen with computed tomography visualized a large mass in the right upper quadrant. The mass was radiologically described as a 22 × 17 × 13 cm heterogeneous mass with its epicenter in the area of the right adrenal gland, with medial and peripheral effacement of all structures in the right upper quadrant. Non-contrasted images demonstrated anterior mid-portion calcifications. The mass parasitized its blood supply from several surrounding structures, including the liver and right psoas muscle, and extensively invaded the psoas muscle. Resection of the mass was performed with pathology, which revealed a high mitotic index and nuclear atypia with two morphologically and immunophenotypically distinct components. One of these components stained positively for calretinin and inhibin, which is indicative of adrenal cortical carcinoma; the other exhibited strong expression of vimentin and desmin, which was concordant with sarcomatous change and confirmed the diagnosis of adrenal cortical carcinosarcoma. This unique histology with both carcinomatous and sarcomatous components presents a diagnostic challenge for clinicians. As such, adrenal carcinosarcomas should be kept on the differential when evaluating retroperitoneal masses. Additionally, this study includes a review of 34 previously reported cases of adrenal cortical carcinosarcomas along with a discussion about the future exploration of this pathology. |
| first_indexed | 2024-03-09T20:22:32Z |
| format | Article |
| id | doaj.art-a37491a064bc4d1480d345f10c37f912 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T20:22:32Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-a37491a064bc4d1480d345f10c37f9122023-11-23T23:44:59ZengMDPI AGDiagnostics2075-44182022-10-011210241910.3390/diagnostics12102419Insights into Clinical Features and Outcomes of Adrenal Cortical CarcinosarcomaZachery Branham0Ashley D. Fox1Asad Ullah2Nikhil G. Patel3Martha Terris4Jigarkumar Parikh5Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USADepartment of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USADepartment of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232, USADepartment of Pathology, Medical College of Georgia at Augusta University, Augusta, GA 30912, USADepartment of Urology, Medical College of Georgia at Augusta University, Augusta, GA 30912, USADepartment of Hematology/Oncology, Georgia Cancer Center, Augusta, GA 30912, USAAdrenal cortical carcinosarcomas are a rare and typically aggressive malignancy with few reported cases in medical literature. We present a case of a 78-year-old female who presented with complaints of fatigue and right shoulder pain. Imaging of the abdomen with computed tomography visualized a large mass in the right upper quadrant. The mass was radiologically described as a 22 × 17 × 13 cm heterogeneous mass with its epicenter in the area of the right adrenal gland, with medial and peripheral effacement of all structures in the right upper quadrant. Non-contrasted images demonstrated anterior mid-portion calcifications. The mass parasitized its blood supply from several surrounding structures, including the liver and right psoas muscle, and extensively invaded the psoas muscle. Resection of the mass was performed with pathology, which revealed a high mitotic index and nuclear atypia with two morphologically and immunophenotypically distinct components. One of these components stained positively for calretinin and inhibin, which is indicative of adrenal cortical carcinoma; the other exhibited strong expression of vimentin and desmin, which was concordant with sarcomatous change and confirmed the diagnosis of adrenal cortical carcinosarcoma. This unique histology with both carcinomatous and sarcomatous components presents a diagnostic challenge for clinicians. As such, adrenal carcinosarcomas should be kept on the differential when evaluating retroperitoneal masses. Additionally, this study includes a review of 34 previously reported cases of adrenal cortical carcinosarcomas along with a discussion about the future exploration of this pathology.https://www.mdpi.com/2075-4418/12/10/2419adrenal carcinosarcomacarcinosarcomaadrenal cancer |
| spellingShingle | Zachery Branham Ashley D. Fox Asad Ullah Nikhil G. Patel Martha Terris Jigarkumar Parikh Insights into Clinical Features and Outcomes of Adrenal Cortical Carcinosarcoma Diagnostics adrenal carcinosarcoma carcinosarcoma adrenal cancer |
| title | Insights into Clinical Features and Outcomes of Adrenal Cortical Carcinosarcoma |
| title_full | Insights into Clinical Features and Outcomes of Adrenal Cortical Carcinosarcoma |
| title_fullStr | Insights into Clinical Features and Outcomes of Adrenal Cortical Carcinosarcoma |
| title_full_unstemmed | Insights into Clinical Features and Outcomes of Adrenal Cortical Carcinosarcoma |
| title_short | Insights into Clinical Features and Outcomes of Adrenal Cortical Carcinosarcoma |
| title_sort | insights into clinical features and outcomes of adrenal cortical carcinosarcoma |
| topic | adrenal carcinosarcoma carcinosarcoma adrenal cancer |
| url | https://www.mdpi.com/2075-4418/12/10/2419 |
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