Abstract
Background : Myxoid adrenocortical tumors are extremely rare, with only 12 adenomas and 13 carcinomas reported in the literature. We report a case of myxoid adrenocortical adenoma and discuss the differential diagnosis.
Case : A 60-year-old Japanese woman on hypertension medication was found in abdominal ultrasonography to have a right adrenal gland tumor, necessitating laparoscopic adrenalectomy. Touch smears of the adrenal tumor showed loose aggregates of variable-sized large oval to polygonal cells in the abundant myxoid background. Scattered elongated fusiform cells were also seen. Nuclei were located in the center of cytoplasm and varied in size. Nuclear chromatin was finely granular and evenly distributed, although some of the nuclei had prominent nucleoli. Alcian-blue-positive myxoid material was confined to the extracellular space and digested by hyaluronidase.
Conclusion : Demonstration of the hyaluronidase-sensitive character of extracellular myxoid material is a clue in the cytopathological diagnosis of myxoid adrenocortical tumors distinguishing them from metastatic mucinous carcinoma. Careful observation of necrosis and mitotic figures are required for the differential diagnosis between benign and malignant myxoid adrenocortical tumors.
