Abstract
Background: We present an intrarenal adrenocortical adenoma discovered incidentally after robot-assisted partial nephrectomy and total adrenalectomy for a suspicious renal mass. Current literature describes the rare occurrence of an adrenocortical adenoma arising from a renal–adrenal fusion. This case represents an uncommon, benign pathology that should be considered in the differential diagnosis of an enhancing renal mass.Case Presentation: The patient is a 62-year-old female found to have an enhancing mass at the anterolateral aspect of the upper pole of the right kidney concerning for renal-cell carcinoma. CT imaging was performed to work up a cause for hyperparathyroidism. During robot-assisted partial nephrectomy, the lesion was found to be partially adherent to the lateral limb of the right adrenal gland. Microscopic evaluation with Melan-A staining showed the mass to be of adrenal origin with benign features and lack of capsulation, indicating an adrenal adenoma arising from intrarenal ectopic adrenal rests.Conclusion: An intrarenal adrenal adenoma arising from ectopic adrenal tissue is a unique pathology that represents a benign differential diagnosis in the evaluation of an enhancing renal mass. However, it cannot be differentiated from renal-cell carcinoma based on cross-sectional imaging alone and requires postoperative pathologic assessment to confirm the diagnosis.
Highlights
Introduction and BackgroundThe occurrence of intrarenal adrenocortical adenoma is exceptionally rare
We present an intrarenal adrenocortical adenoma discovered incidentally after robot-assisted partial nephrectomy and total adrenalectomy for a suspicious renal mass
Microscopic evaluation with Melan-A staining showed the mass to be of adrenal origin with benign features and lack of capsulation, indicating an adrenal adenoma arising from intrarenal ectopic adrenal rests
Summary
One study conducted for more than 13 years at Johns Hopkins University found only one case of a cortical adenoma arising within the renal parenchyma.[1] On CT, an intrarenal adenoma may appear as a solid enhancing renal mass and may lead to the presumptive diagnosis of renal-cell carcinoma.[2] In general, such a case will not be discovered to be benign until pathologic analysis of the surgical specimen is conducted after partial or radical nephrectomy. Robotic partial nephrectomy and adrenalectomy were performed for a suspected renal-cell carcinoma with pathologic analysis revealing a benign intrarenal adrenocortical adenoma arising from rests of ectopic adrenal tissue in the superior pole of the kidney. Confirmatory of adrenal origin and excluding a primary renal neoplasm, the tumor was diffusely positive by immunohistochemistry for Melan-A, an adrenal marker (Fig. 2D), and negative for PAX8, a sensitive marker of renal origin
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
