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Al-Janabi MH, Salamah D, Suleiman M, Mansour M, Salloum R. Ectopic adrenal tissue in the mesosalpinx of an older female: the fourth case report in the literature. Oxf Med Case Reports 2024; 2024:omae024. [PMID: 38680768 PMCID: PMC11049563 DOI: 10.1093/omcr/omae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/10/2024] [Accepted: 02/26/2024] [Indexed: 05/01/2024] Open
Abstract
Ectopic adrenal tissue is a rare finding often encountered incidentally during histopathological examinations. The most common site is the genitourinary tract and pelvis, and more frequently in males than females. Ectopic adrenal tissue is primarily found in neonates and is extremely rare in adults. Although it is an unexpected entity, pathologists should be aware of it because it may be confused with metastasis of clear cell renal carcinoma. To the best of our knowledge, only three cases of ectopic adrenal tissue in the mesosalpinx of the fallopian tube have been reported in the medical literature, making this case the fourth one. In our report, we discussed an ectopic adrenal tissue that was discovered incidentally in the mesosalpinx of an older female.
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Affiliation(s)
| | - Doaa Salamah
- Tishreen University Faculty of Medicine, Lattakia, Syria
| | - Marah Suleiman
- Tishreen University Faculty of Medicine, Lattakia, Syria
| | - Marah Mansour
- Tishreen University Faculty of Medicine, Lattakia, Syria
| | - Rabab Salloum
- Department of Pathology, Tishreen University Hospital, Lattakia, Syria
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Singh Y, Bharti JN, Vishnoi JR. Serous Cystadenoma with Ectopic Adrenal Cell Rest of Ovary: A Rare Case Report. J Midlife Health 2022; 13:325-327. [PMID: 37324793 PMCID: PMC10266566 DOI: 10.4103/jmh.jmh_156_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/30/2022] [Accepted: 01/25/2023] [Indexed: 06/17/2023] Open
Abstract
Ectopic adrenal tissue is an uncommon entity in females. It is usually seen in male children, and the commonly involved sites are the kidney, retroperitoneum, spermatic cord, and paratesticular region. The ectopic adrenal gland in adults has been described in few studies only. Ectopic adrenal tissue was diagnosed as an incidental finding in histopathological examination of serous cystadenoma of the ovary. A 44-year-old female presented with a complaint of vague abdominal discomfort for the past few months. Ultrasound was suggestive of a left ovarian complex cystic lesion. The histopathological examination revealed serous cystadenoma with ectopic adrenal cell rest. Here, we present this case as it is a rare finding incidentally detected in a patient being operated on for a different pathology.
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Affiliation(s)
- Yasmeen Singh
- Department of Pathology, AIIMS, Jodhpur, Rajasthan, India
| | | | - Jeewan Ram Vishnoi
- Department of Surgical Oncology, AIIMS Surgical Oncology, Jodhpur, Rajasthan, India
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Abstract
Ectopic adrenal rests are a rare condition which can be found in various sites, generally in the retroperitoneum or pelvis along the path of gonadal descent. Their real prevalence is unknown. Males are more commonly affected, at least in the pediatric age. Adrenal rests are usually clinically silent and incidentally found in surgical samples, mostly in the pediatric population, and rarely in adults. With the aim of increasing knowledge and estimating the prevalence of ectopic adrenocortical tissue in the adult population, 44 adrenal rests in the urogenital tract of 40 adults are described. These represent approximately 0.07% of the total number of urogenital and gynecological surgeries performed in the 22 considered years. Adrenal rests were identified in the spermatic cord (10 males) and in paraovarian, parasalpingeal, or infundibulopelvic ligament locations (30 females). All but one was incidental findings. One case regarded an adrenocortical carcinoma arisen in adrenal rests. A literature review of adrenal ectopia in the urogenital tract of adults identified 57 reported cases from 53 patients, with similar clinicopathological features as those of our series, with the exception of a lower incidence of parasalpingeal locations. Despite their limited clinical implications, awareness of ectopic adrenal rests is essential also in adults for at least two reasons: (a) to correctly identify sources of adrenocortical hormone production in case of adrenal insufficiency or hormonal imbalance and (b) to avoid misinterpretations in the diagnostic workup of renal cell carcinoma, adrenocortical tumors, and rare gonadal neoplasms, including Sertoli/Leydig cell tumors.
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Affiliation(s)
- Enrico Costantino Falco
- Pathology Unit, Department of Medical Sciences, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
| | | | - Jasna Metovic
- Pathology Unit, Department of Oncology, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
| | - Enrico Bollito
- Pathology Unit, San Luigi Hospital, Orbassano, Turin, Italy
| | | | - Marco Volante
- Pathology Unit, Department of Oncology at San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
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Uğur Kılınç AN, Bayramoğlu Z, Ünlü Y, Keçeli AM, Dönmez Mİ. Incidental ectopic adrenal cortical tissue: Retrospective analysis of 16 patients. J Pediatr Urol 2021; 17:258.e1-258.e6. [PMID: 33526369 DOI: 10.1016/j.jpurol.2020.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/21/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate ectopic adrenal cortical tissue (EACT) and identify clinical, pathological and radiological aspects. STUDY DESIGN Retrospective review of pathology reports in a single tertiary institution between 2010 and 2020 was conducted. Patients diagnosed with EACT were included for analysis. Demographic characteristics, accompanying pathologies and clinicopathological and radiological findings of these patients were analyzed. RESULTS There was a total of 17 patients in the cohort. Fifteen were boys and 2 were adults (1 male). The mean diameter of the EACT nodule was 0.25 cm (range 0.2-0.5 cm). All EACTs were incidentally diagnosed. Seven EACTs were diagnosed during an inguinal hernia repair, 6 during orchidopexy, 1 during partial orchiectomy, 2 during orchiectomy and 1 during hysterectomy and bilateral salpingoophorectomy due to uterine prolapse. DISCUSSION EACT is a rare entity that is mostly found incidentally during inguinoscrotal interventions. Radiological discrimination of EACT may not be easy and thus, not detected prior to surgery. Clinical significance of EACT is not very well understood, however it tends to be a benign pathology. Although it is more commonly found in children, adults may present with EACT, as well. CONCLUSION A tiny yellowish nodule detected in the inguinoscrotal region should be suspected for EACT by pediatric urologists, surgeons, and pathologists.
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Affiliation(s)
| | | | - Yaşar Ünlü
- Konya Training and Research Hospital, Pathology, Konya, Turkey.
| | - Avni Merter Keçeli
- Konya Training and Research Hospital, Radiology, Pediatric Radiology, Konya, Turkey.
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Tzigkalidis T, Skandalou E, Manthou ME, Kolovogiannis N, Meditskou S. Adrenal Cortical Rests in the Fallopian Tube: Report of a Case and Review of the Literature. Medicines (Basel) 2021; 8:medicines8030014. [PMID: 33809106 PMCID: PMC7999680 DOI: 10.3390/medicines8030014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/16/2022]
Abstract
We report an extremely unusual finding discovered incidentally during a routine pathologic evaluation of a fallopian tube, surgically removed on the grounds of ectopic pregnancy. We came across a minute yellowish nodule situated within the wall of the salpinx, which corresponded to ectopic adrenal cortex, as verified by microscopical examination, and coexisted with salpingitis isthmica nodosa. A research of the available English literature on this subject confirmed the rareness of the entity we encountered. This case is presented because of its uniqueness, aiming to raise awareness of a rare condition which is discussed along with potential diagnostic dilemmas, its prognostic significance, and possible complications.
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Affiliation(s)
| | - Eleni Skandalou
- Internal Medicine Department, General Hospital “Papanikolaou”, 57010 Thessaloniki, Greece;
| | - Maria Eleni Manthou
- Laboratory of Histology-Embryology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Correspondence: ; Tel.: +30-2310999070
| | - Nikolaos Kolovogiannis
- Obstetrics and Gynecologic Department, General Hospital of Polygyros, 63100 Chalkidiki, Greece;
| | - Soultana Meditskou
- Laboratory of Histology-Embryology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
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Abstract
Case summary An 11-year-old female, reportedly spayed, domestic shorthair cat was examined for a 4-month history of weight loss, aggression, urine spraying, malodorous urine and estrus-like behavior. Physical examination revealed thickened skin, a mildly prominent vulva and confirmed malodorous urine. On abdominal ultrasonography, a 6 mm hypoechoic nodule was found in the left cranial abdomen. An adrenocorticotropic hormone (ACTH) stimulation test with adrenal panel revealed elevated serum concentrations of androstenedione and testosterone pre- and post-cosyntropin stimulation, mildly decreased cortisol pre- and post-cosyntropin stimulation, and decreased resting aldosterone. Exploratory laparotomy was performed and a cystic, nodular mass was found in the region of the left ovary. The mass was surgically removed and submitted for histopathology; results were conclusive for an ovarian remnant with an intact corpus luteum and non-neoplastic parovarian cysts. Previously observed clinical signs resolved within two weeks of ovariectomy. A follow-up ACTH stimulation test with adrenal panel 6 weeks postoperatively revealed normalization of serum androstenedione, testosterone and cortisol concentrations. Four years postoperatively, at the time of writing, the cat remains free of clinical signs. Relevance and novel information We are unaware of any previously reported cases of non-neoplastic ovarian remnants associated with clinically relevant hyperandrogenism. A non-neoplastic ovarian-dependent hyperandrogenism should be included as a differential diagnosis of spayed female cats showing aggression and urine spraying behavior.
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Affiliation(s)
- Sarah A Jones
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Scott L Owens
- Department of Internal Medicine, MedVet Indianapolis, Carmel, IN, USA
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Chew KT, Abu MA, Arifuddin Y, Mohamed Ismail NA, Nasir NAM, Mohammed F, Nur Azurah AG. Ectopic adrenal tissue associated with borderline mucinous cystadenoma of ovary: a case report with review of the literature. Horm Mol Biol Clin Investig 2017; 32:/j/hmbci.ahead-of-print/hmbci-2017-0021/hmbci-2017-0021.xml. [PMID: 28930625 DOI: 10.1515/hmbci-2017-0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/16/2017] [Indexed: 11/15/2022]
Abstract
Ectopic adrenal tissue in the ovary is a rare entity. We reported a case of ectopic adrenal tissue in borderline mucinous cystadenoma of the left ovary. A 22 year-old student presented with progressive abdomen distension associated with discomfort for 3 months. Imaging investigation was suggestive of mucinous left ovarian cyst. Left salpingo-oophorectomy was performed and the histopathology revealed borderline mucinous cystadenoma with an incidental finding of ectopic adrenal tissue. This is an interesting case because of its rarity and potential risk of neoplasm changes.
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Affiliation(s)
- Kah Teik Chew
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia, Phone: +603-91455956
| | - Muhammad Azrai Abu
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Yulianty Arifuddin
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Nor Azlin Mohamed Ismail
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Noor Ain Mohd Nasir
- Department of Pathology, Histopathology Unit, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Fazarina Mohammed
- Department of Pathology, Histopathology Unit, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Abdul Ghani Nur Azurah
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
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