Updates in Surgery

, Volume 65, Issue 2, pp 161–164 | Cite as

Corticomedullary mixed tumor of the adrenal gland—a clinical and pathological chameleon: case report and review of literature

  • G. Donatini
  • S. Van Slycke
  • S. Aubert
  • B. Carnaille
Case Report

Abstract

Adrenal tumors mostly present with specific and unique clinical features, regarding their endocrine metabolism. A 53-year-old man came to our Department for a left adrenal mass discovered incidentally. Biochemical and imaging findings were suspicious for a pheochromocytoma. The patient underwent a laparoscopic left adrenalectomy. A well-circumscribed 5.5-cm mass was removed. It was composed of adrenal cells intimately admixed with pheochromocytes. Immunohistochemical studies were positive both for cortical cells (inibin-α, synaptophysine and melan-A) and medullary cells (S-100 and chromogranine A). Final pathology was of corticomedullary mixed tumor (CMT). CMT is a rare tumor with 14 cases previously reported in literature, with wide variable biochemical behavior, such as his radiological and pathological features. Prevalence and actual malignant potential are yet unknown to our knowledge.

Notes

Conflict of interest

None.

References

  1. 1.
    Korobin M, Francis IR, Kloos RT, Dunnick NR (1996) The incidental adrenal mass. Radiol Clin North Am 34:1037–1054Google Scholar
  2. 2.
    Young WF (2007) The incidentally discovered adrenal mass. N Engl J Med 356:601–610PubMedCrossRefGoogle Scholar
  3. 3.
    Mathison DA, Waterhouse CA (1969) Cushing’s syndrome with hypertensive crisis and mixed adrenal cortical adenoma-pheochromocytoma (corticomedullary adenoma). Am J Med 47:635–641PubMedCrossRefGoogle Scholar
  4. 4.
    Wienecke JA, Thompson LD, Heffes CS (2001) Corticomedullary mixed tumor of the adrenal gland. Ann Diagn Pathol 5:304–308CrossRefGoogle Scholar
  5. 5.
    Ohta TI, Motoyoma T, Imai T et al (1995) Cortico-medullary mixed tumor (pheochromocytoma and cortical adenoma) of the adrenal gland. J Urol Pathol 3:157–164Google Scholar
  6. 6.
    Michal M, Havlicek F (1996) Corticomedullary tumors of the adrenal glands. Report of two cases. Association of corticomedullary tumor with spindle cell sarcoma. Pathol Res Pract 192:1082–1089PubMedCrossRefGoogle Scholar
  7. 7.
    Tissier F, Le Charpentier M, Guilhaume B et al (2002) Adrenal corticomedullary adenoma. An entity to know. Ann Pathol 22(6):493–494PubMedGoogle Scholar
  8. 8.
    Chu AY, LiVolsi VA, Fraker DL et al (2003) Corticomedullary mixed tumor of the adrenal gland with concurrent adrenal myelolipoma. Arch Pathol Lab Med 127:e329–e332PubMedGoogle Scholar
  9. 9.
    Lee P, Bradbury RA, Sy J, Hughes L, Wong L, Falk G, Chen R (2008) Phaeochromocytoma and mixed corticomedullary tumour—a rare cause of Cushing’s syndrome and labile hypertension in a primigravid woman postpartum. Clin Endocrinol (Oxf). 68(3):492–494 [Epub 13 Sep 2007]Google Scholar
  10. 10.
    Kimura T, Usui T, Inamoto S et al (2009) Pheochromocytoma with subclinical Cushing’s syndrome caused by corticomedullary mixed tumor of the adrenal gland. J Clin Endocrinol Metab 94(3):746–747PubMedCrossRefGoogle Scholar
  11. 11.
    Alexandraki KI, Michail OP, Nonni A et al (2009) Corticomedullary mixed adrenal tumor:case report and literature review. Endocr J 56(6):817–824PubMedCrossRefGoogle Scholar
  12. 12.
    Trimeche AS, Chadli CM, Mokni M et al (2009) Corticomedullary mixed tumor of the adrenal gland. Ann Endocrinol (Paris) 70(6):473–476CrossRefGoogle Scholar
  13. 13.
    Lau SK, Chu PG, Weiss LM (2011) Mixed cortical adenoma and composite pheochromocytoma–ganglioneuroma: an unusual corticomedullary tumor of the adrenal gland. Ann Diagn Pathol 15(3):185–189 [Epub 29 Apr 2010]PubMedCrossRefGoogle Scholar
  14. 14.
    Akai H, Saoyama K, Namai K et al (1993) A case of adrenal mixed tumor of pheochromocytoma and adrenocortical adenoma presenting diabetes mellitus and hypertension. Nippon Naibunpi Gakkai Zasshi 69:659–669PubMedGoogle Scholar
  15. 15.
    Hu WL, Cao QY, He HX et al (2002) Misdiagnosis of corticomedullary mixed pathological changes in adrenals: report of 4 cases. Di Yi Jun Yi Da Xue Xue Bao 22:1145–1147PubMedGoogle Scholar
  16. 16.
    Li ZL, Sun D, Kong CZ (2009) Diagnosis and treatment for the corticomedullary mixed tumor of adrenal gland. Zhonghua Wai Ke Za Zhi 47(16):1239–1241PubMedGoogle Scholar
  17. 17.
    Cope O, Labbe JP, Raker JW, Bland EF (1952) Pheochromocytoma and adrenal cortical adenoma. Report of a case with both tumors and discussion of their relation. J Clin Endocrin Metab 12:875–880CrossRefGoogle Scholar
  18. 18.
    Sato H, Igarashi H, Kishimoto Y et al (2002) Combined tumor consisting of non-functioning adrenocortical adenoma and pheochromocytoma in the same gland. Int J Urol 9(7):398–401PubMedCrossRefGoogle Scholar
  19. 19.
    Cotesta D, Petramala L, Serra V et al (2006) Pheochromocytoma associated with adrenocortical tumor in the same gland. Two case reports and literature review. Minerva Endocrinol 31(2):18318–18319Google Scholar
  20. 20.
    Hwang WR, Ma WY, Tso AL, Pan CC, Chang YH, Lin HD (2007) Pheochromocytoma and adrenocortical adenoma in the same gland. J Chin Med Assoc 70(7):289–293PubMedCrossRefGoogle Scholar
  21. 21.
    Carey RM, Varma SK, Drake CR Jr, Thorner MO, Kovacs K, Rivier J, Vale W (1984) Ectopic secretion of corticotropin-releasing factor as a cause of Cushing’s syndrome. A clinical, morphologic, and biochemical study. N Eng J Med 311:13–20CrossRefGoogle Scholar
  22. 22.
    Ehrhart-Bornstein M, Hinson JP, Bornstein SR et al (1998) Intra-adrenal interactions in the regulation of adrenocortical steroidogenesis. Endocr Rev 19(2):101–143PubMedCrossRefGoogle Scholar
  23. 23.
    Schinner S, Bornstein SR (2005) Cortical–chromaffin cell interactions in the adrenal gland. Endocr Pathol 16(2):91–98PubMedCrossRefGoogle Scholar
  24. 24.
    Stachowiak MK, Rigual RJ, Lee PHK (1998) Regulation of tyrosine hydroxylase and phenylethanolamine N-methyltransferse mRN A levels in the sympathoadrenal system by the pituitary–adrenocortical axis. Brain Res 427:275–286Google Scholar
  25. 25.
    Schwartz LH, Macari M, Huvos AG, Panicek DM (1996) Collision tumors of the adrenal gland: demonstration and characterization at MR imaging. Radiology 201(3):757–760PubMedGoogle Scholar
  26. 26.
    Khati NJ, Javitt MC, Schwartz AM (1999) Adrenal adenoma and hematoma mimicking a collision tumor at MR imaging. Radiographics 19:235–239PubMedGoogle Scholar
  27. 27.
    Thorin-Savouré A, Tissier-Rible F, Guignat L et al (2005) Collision/composite tumors of the adrenal gland: a pitfall of scintigraphyc imaging and hormone assays in the detection of adrenal metastasis. J Clin Endocrinol Metab 90(8):4294–4929CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • G. Donatini
    • 1
    • 2
  • S. Van Slycke
    • 1
  • S. Aubert
    • 1
  • B. Carnaille
    • 1
  1. 1.Department of General and Endocrine SurgeryCHR HuriezLille CedexFrance
  2. 2.Lille CedexFrance

Personalised recommendations