engleski

Fine Needle Aspiration Cytology of Adrenocortical Carcinoma: Case Report

Adrenocortical carcinoma (ACC) is a malignant epithelial tumour of adrenal cortical cells. Approximately half of all ACCs are hormonaly functional. A 49-year-old woman presented for hirsutism, deep voice and hypertension. Ultrasonography (US) revealed a solitary tumor mass, 8 cm in size, of the right adrenal gland. Laboratory tests showed it to be a hormonally active, androgen secreting tumour (elevated testosterone level), which was consistent with the clinical picture of the disease. After histopathologic analysis tumor was signet out as adrenocortical carcinoma, a low risk carcinoma according to Weiss’ classification. On regular follow up US study performed at one year, a 65x43 mm growth was diagnosed in the lower pole of the right kidney. The finding was verified by computerized tomography and the patient was reoperated on. Exploration revealed secondary growth in the region of greater omentum, without infiltration of adjacent organs. Histopathologic analysis confirmed metastatic ACC. At 8 months of the second operation and after 6 chemotherapy cycles according to EAP protocol, enlarged paraaortic lymph nodes and a node along the upper pole of the right kidney were diagnosed by cytologic puncture. Cytologic analysis showed numerous large tumor cells (individual and in papillary clusters) with polymorphic, hyperchromic, irregular nuclei, prominent nucleoli with perinucleolar halo, and abundant pale basophilic cytoplasm. The cells were positive for vimentin, NSE, synaptophysin and epithelial markers (BerEP4 and epithelial membrane antigen - EMA). ACC is a rare tumor of high malignant potential. Morphologically (histopathology and cytology), there is the problem of differential diagnosis from adenoma on the one hand, and from renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC) on the other hand. A combined evaluation of clinical features , size or weight, microscopic appearance, immunohistochemical and molecular genetic data is necessary.

Adrenocortical carcinoma; FNAC

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