PMC9266659_01
(A) In pre-operative photos seems overweight with excessive hair growth all over her body (hirsutism) and pustular acne on her face. (B) 6-month post-op photos show a dramatically reduced body weight, appearing similar to her age group, and a total absence of body hair.
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She had cushingoid facies, signs of virilization in the form of pustular acne, hirsutism (axillary and facial hair in Figure 1A), and clitoromegaly. And all the symptoms disappeared 6 months after the operation (Figure 1B).
Abdominal ultrasound shows well-defined adrenal mass appearing slightly heterogeneous mixed hyper and hypoechoic consistent with smooth margins (white arrow).
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As usual in pediatric cases, in the beginning, an abdominal ultrasound (US) was performed, showing a well-defined adrenal mass with a slightly heterogeneous mix of hyper- and hypoechoic consistency with smooth margins (Figure 2).
Axial and coronal contrast-enhanced abdominal computed tomography showed that 6 cm right adrenal fossa well-defined heterogeneously enhanced mass lesion containing hypodense necrotic areas and slightly displaces right kidney inferiorly (blue arrow).
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For further investigation and lesion characterization, computed tomography (CT) of the abdomen has done, revealing that the right adrenal fossa well-defined a 6 cm sized mass lesion with heterogeneous contrast enhancement containing hypodense necrotic areas and slightly displaces right kidney inferiorly (Figure 3).
Histopathological examination shows (A) encapsulated tumor composed of variably sized nests, large sheets, and trabeculae, areas of necrosis, hemorrhage, and degeneration areas. (B) Low grade: <=20 mitoses/50 high power fields morphologic subtypes, Oncocytic (>75% oncocytic cells). (C) Large cells with granular clear to eosinophilic cytoplasm, pleomorphic Intranuclear inclusions, mitoses, and atypical mitoses. (D) Gross surgical specimen of a removed adrenal mass.
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Next, the solid mass was excised by means of unilateral right adrenalectomy (Figure 4). According to these findings, the case was diagnosed with oncocytic ACC (Figure 4).