PMC5173498_01
(a) Computed tomography (CT) showed a heterogeneous mass measuring approximately 16x14x11 cm between the right kidney and liver. (b) Enhanced CT showed that the adrenal gland was unevenly stained. (c) T1-weighted magnetic resonance imaging (MRI) showed high-signal intensity within the tumor, indicating necrosis and bleeding. (d) T2-weighted MRI showed high-signal intensity within the entire tumor. (e) I-131 adosterol scintigraphy showed an increased uptake corresponding to the right adrenal gland, with suppression on the other side.
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Iodine-131 adosterol scintigraphy revealed an uptake at the site corresponding to the right adrenal gland and suppression on the left side (Fig. 1).
The left upper panel shows the excised adrenal gland. The left lower panel shows a section of the adrenal gland. The middle upper panel shows Hematoxylin and Eosin (H&E) staining of the adrenal gland (400x), indicating vascular invasion. The middle lower panel shows immunostaining with an antibody against SF-1. The right upper panel shows H&E staining of the adrenal gland (400x). The right lower panel shows immunostaining with an antibody against Ki67; the Ki67 labeling index of the hot spot was 18%.
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The tumor included cellular components with a clear cytoplasm forming a"Zellballen"structure, and cells with eosinophilic abundant cytoplasm were associated with the thin fibrotic vascular interstitium (p0, T2, N0, M0) (Fig. 2). As shown in Fig. 2, the tumor satisfied seven of nine items in the Weiss criteria: (1) nuclear atypia, (2) mitosis, (3) capsular invasion, (4) confluent necrosis, (5) cytoplasm, (6) architecture, and (7) sinusoidal invasion, indicating that the adrenal tumor might be malignant.
A steroidogenic enzyme pattern indicating disorganized steroidogenesis. Aromatase, 17betaHSD1, STS, and 5alpha-reductase 1 were not expressed in most tumor cells. However, STS and 5alpha-reductase 2 were expressed in some tumor cells. 17betaHSD5 was diffusely expressed in all tumor cells. The immunohistological studies strongly suggested the production of testosterone by the adrenal tumor.
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The diffuse expression of 17-beta hydroxysteroid dehydrogenase 5(17-beta-HSD5) was present in the tumor, pathologically indicating a testosterone-producing tumor (Fig. 3).
RT-PCR demonstrated the expression of exon II, promoter II, and exon I.3 for each sample. eII: exon II, pII: promoter II, eI.3: exon I.3
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II, promoter II, and exon I.3 (Fig. 4). In the tested ovary, the expression of exon II, promoter II, and exon I.3 was positive.