Myxoid variant of adrenocortical carcinoma in a middle aged female - A case report

Adrenocortical neoplasms are rare tumours that can be diagnostically challenging in some cases. Numerous diagnostic algorithms and scoring systems are in practice to differentiate adenoma from carcinoma. Besides, the different histological variants of adrenocortical carcinoma need to be identified. We present a case of 44 year old female with vaginal bleeding with a large, heterogenous suprarenal mass on imaging. Provisional clinical diagnosis of pheochromocytoma was made and patient underwent adrenalectomy. The histological examination of tumour sections showed sheets and trabeculae of moderately pleomorphic cells with extracellular mucin deposition. Immunohistochemical evaluation showed tumour cells to be negative for chromogranin with focal pan cytokeratin positivity. Finally a diagnosis of adrenal cortical carcinoma – myxoid variant was made. Post operative period was uneventful and following en bloc resection of the tumour patient did not receive any adjuvant adrenolytic treatment. The patient is doing well at 6 months of follow up period, without any evidence of recurrence. Keywords: Adrenal cortical malignancy, Cytokeratin, Histopathology, Immunohistochemistry, Myxoid.