PMC9373900_01
Clinical images of the patient (A) Enhanced CT scan showing a 40-mm round tumor with a relatively reduced contrast effect in the right renal hilum. (B) Remarkable 131I-labelled adosterol accumulation in the tumor but not in the adrenal glands. (C) CT scan showing dissymmetric bone thickening with a "ground-glass" appearance, which consisted of cystic or solid mass at right-frontoparietal region of the temporal bone. (D)
99mTc-methylene diphosphonate (MDP) accumulation in the skull lesion.
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Coincidentally, an enhanced CT scan showed a 40-mm round tumor on the right renal hilum (Figure 1A); the tumor remarkably accumulated 131I-labelled adosterol but not in the adrenal glands (Figure 1B). In addition, a head CT scan showed dissymmetric bone thickening with a "ground-glass" appearance, which consisted of a cystic or solid mass at right-frontoparietal region of the temporal bone (Figure 1C). Bone scintigraphy showed that 99mTc-methylene diphosphonate (MDP) accumulated in multiple bones, including skull lesions (Figure 1D), suggesting that these bone features were caused by fibrous dysplasia.
Immunohistochemical staining of the tumor on the right renal hilum Immunohistochemical staining confirmed a pituitary adenoma that was markedly positive for (A) StAR, (B) CYP11A1, (C) CYP17A, (D) HSD3B, (E) CYP21A, (F) CYP11B1, and (H) SF-1. (G and I) Staining for CYP11B2 and Ki-67 was negative.
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Positive immunohistochemical staining for StAR, CYP11A1, CYP17A, HSD3B, CYP21A, CYP11B1, and SF-1 (Figures 2A-F, H) indicated that the tumor was capable of producing cortisol from cholesterol, a source reagent, via an authentic enzymatic reaction. In contrast, staining for CYP11B2 and Ki-67 was negative (Figures 2G, I).