UNILATERAL ADRENAL HETEROTOPIA WITH RENAL-ADRENAL FUSION

Abstract

An 83-year-old white woman presented for evaluation of diffuse upper abdominal pain and weight loss. Physical examination demonstrated no tenderness or abdominal masses. Blood pressure was normal. Computerized tomography of the abdomen and pelvis revealed a 2.9 X 2.2 cm. solid mass in the upper pole of the right kidney. Laboratory studies, including renal function, hormonal evaluation and hematological parameters, were normal, and urinalysis was negative. Upper pole partial nephrectomy was performed en bloc with the adrenal gland through a flank incision. Histological examination of the specimen was remarkable for fusion of the adrenal gland with the kidney and adrenal cortical clear cells admixed with renal parenchyma (part A of figure). Renal cystic changes were noted at the junction of the fusion. Immunohistochemical stains for epithelial membrane antigen (part B of figure), pan cytokeratin and cytokeratin 7 were positive in the renal tissue, and negative in the extrarenal and intrarenal adrenal tissue, confirming heterotopia. The patient did well postoperatively. DISCUSSION