A 40-year-old female presented with right flank pain for 3 months. Imaging showed a right lumbar mass. A biopsy was performed which led to surgery to remove a large right adrenal gland tumor weighing 250 grams. Pathology results found the tumor to be an adrenal cortical carcinoma.

1. 40 yr Female –c/o Rt flank pain – 3 months .
US – Rt lumbar mass.
USG FNA of Lumbar mass done.
CASE NO 13

19. Diagnosis ?

20. • C/O giddiness - 1 month
• Amenorrhea – 3 months
• Recently diagnosed as HTN, on medication.
• O/E – Hirsutism, acne vulgaris , cushingoid
habitus.

21. INVESTIGATIONS :
RBS, LFT, RFT, CBC, CXR, ECHO – N.
• Total calcium – 9mg/dl.(N-8.5 – 11.5)
• Cortisol – 29.71 .(3.09 – 22.40)
• VMA – 2mg/24 hrs (N <13.6mg/24hrs).
• FSH , LH – < 0.66m IU ,< 0.21m IU (dec).
• Prolactin – 40.50ng/ml (N 4.79 – 15.2ng/ml)

22. • Testesterone - 501ng/dl (N 8.4 -48.1)
• Free testesterone 17.08ng/dl (N 0.12 -1.12)
• Bioavailable testesterone 355.87ng/dl
(N 2.30 – 26.8)
• SHBG 13.68 (N 40 – 120nmol/l)
• DHEA SULPHATE >1000mcg/dl (N 12 – 379)

23. • US ABD – large irregular hypodense solid mass
lesion arising from the Right adrenal gland m
12X8X7 cm. Right kidney pushed down by the
mass .kidneys are normal. No LN
• MRI & CECT – HTN pt with right cerebellar infarct
and right adrenal mass
? pheochromocytoma

24. • Right Adrenelectomy done
• Wt 250 gms
• Sp 11X8X7cms
• E/S – well encapsulated , nodular , ?breach
• C/S – heterogenous ,11X8X7cm , g/br –g/w -
yellowish

37. INHIBIN

38. MELAN A

39. EMA
CHR
Ki6
7

40. • IHC
INHIBIN - POSITIVE
MELAN A – POSITIVE
CHR – NEGATIVE
EMA - NEGATIVE

41. • Cytology Diagnosis: Adrenal cortical carcinoma
/ pheochromocytoma
• Cell Block: Adrenal cortical carcinoma
• HPE : Adrenal cortical carcinoma - Right adrenal

42. • D/D
ACC /Adenoma
Pheochromocytoma
HCC
RCC