10x   Low mag

Clinical History

A 68 year old woman presents with a 5.8 cm adrenal mass identified incidentally during an ultrasound for gallstones.

Choose the Correct Diagnosis: 

  1. Angiomyolipoma
  2. Pheochromocytoma
  3. Leiomyoma
  4. Adrenal cortical sarcomatoid carcinoma

Answer: C, Leiomyoma.

HMB45   sma

Discussion:

In the low mag image, normal adrenal cortex is present at the top of the photograph. Beneath the adrenal cortex there is a bland spindle cell tumor that grows in fascicles. The tumor is cytologically bland and lacks the epithelioid characteristics of pheochromocytoma and the atypia of a sarcomatoid carcinoma. The differential is angiomyolipoma vs leiomyoma. No fat or abnormal vessels are identified however angiomyolipoma remains a possibility. Immunostains for HMB45 and Mart-1 are negative. A smooth muscle myosin heavy chain immunostain is strongly positive. This is a rare tumor of the adrenal medulla. Less than 20 cases are reported in the literature.

Lin J, Wasco MJ, Korobkin M, Doherty G, Giordano TJ. Leiomyoma of the adrenal gland presenting as a non-functioning adrenal incidentaloma: case report and review of the literature. Endocr Pathol. 2007 18(4):239-43. doi: 10.1007/s12022-008-9013-7.

PMID:18197480

Contributed by Thomas Winokur, M.D., Professor, Anatomic Pathology, UAB Department of Pathology