A case of a borderline adrenal oncocytoma in a 62-year old female

INTRODUCTION

Adrenal oncocytomas are a rare pathology and only about 160 cases have been reported in the literature.

CASE DESCRIPTION

We describe the case of a 62-year old female with an incidentaloma found in the right adrenal gland on a CT scan. Endocrine testing showed a non-secreting lesion. An MRI was performed to get a more precise diagnosis. It excluded a simple adenoma and a malignant tumor had to be suspected. Open adrenalectomy was performed, and pathology results confirmed a borderline adrenal oncocytoma.

DISCUSSION

Oncocytomas are usually found in the kidneys, salivary glands, parathyroid, lung, pituitary gland, and ovaries. It is important to differentiate them from, for example, pheochromocytomas, adrenal cortical carcinoma, and metastasis. Most oncocytomas are non-functioning (17% are functional). Usually, they are found as incidentalomas on a CT or MRI scan. The only way to confirm the diagnosis at present is pathological examination. Bisceglia and his colleagues have proposed a new system to classify adrenal oncocytomas. The presence of one major criterion indicates malignancy, the presence of one to four minor criteria is indicative of uncertain potential. The absence of all major and minor criteria indicates benign behavior. Treatment options are open surgery, laparoscopic surgery and rarely robotic surgery.

CONCLUSION

An adrenal oncocytoma remains a rare diagnosis and has a wide array of differential diagnosis. It should be treated by surgical removal and a close follow up is suggested. More research should be done regarding diagnosis, treatment and follow-up.

Femoral anteversion measurement : evaluation of inter- and intraobserver reliability

The aim of this study was to evaluate the inter- and intraobserver reliability of a CT-based femoral anteversion measurement. 17 CT scans showing an abnormal anteversion on one side were presented to 6. Three measurements of all scans were obtained : two bilateral measurements and a third measurement with a flipped CT scan. Interobserver correlation results using the spearman test for left, right and anteversion difference had a mean of respectively : 0.918, 0.760 and 0.757. Intraobserver correlation had a maximum of respectively : 0,99, 0,89 and 0,94. Correlation coefficients were consistently higher for the second measurement. The lower correlation boarder of 0,8 was often exceeded. Intraobserver correlation was higher than interobserver correlation. As we evaluated a high variance in interobserver reliability, we recommend an accurate and objective measurement of the anteversion angle. A personal measurement and comparison to the radiological protocol is necessary.

A systematic review comparing the diagnostic value of 14-3-3 protein in the cerebrospinal fluid, RT-QuIC and RT-QuIC on nasal brushing in sporadic Creutzfeldt-Jakob disease

BACKGROUND

Sporadic Creutzfeldt-Jakob disease (sCJD) is a human prion disease that is a relatively common differential diagnosis in dementia patients. Therefore it needs a good diagnostic tool. Brain autopsy is the golden standard for the diagnosis of CJD; however, a less invasive technique is 14-3-3 protein measurement in the cerebrospinal fluid (CSF). In this systematic review, we compared the diagnostic value of the 14-3-3 protein measurement to the newer RT-QuIC test and a variant of RT-QuIC where nasal brushing is used to collect the samples.

METHODS

The search via MeSH terms and quality assessment was carried out by two individual researchers.

RESULTS

In 14-3-3 and RT-QuIC the sensitivity was comparable, respectively, 88% and 86%. Specificity however was higher in RT-QuIC 99.5% compared to 80% in 14-3-3. Nasal brushing showed the best results with a sensitivity of 97% and a specificity of 100%.

CONCLUSION

Nasal brushing, despite being the best diagnostic tool according to the data, needs more study since there has only been a few studies regarding the technique. It is safe to say that due to the high specificity, RT-QuIC is superior to 14-3-3 testing.