40 yr Female –c/o Rt flank pain – 3 months .

US – Rt lumbar mass.

USG FNA of Lumbar mass done.

CASE NO 13

Diagnosis ?

• C/O giddiness - 1 month

• Amenorrhea – 3 months

• Recently diagnosed as HTN, on medication.

• O/E – Hirsutism, acne vulgaris , cushingoid

habitus.

INVESTIGATIONS :

RBS, LFT, RFT, CBC, CXR, ECHO – N.

• Total calcium – 9mg/dl.(N-8.5 – 11.5)

• Cortisol – 29.71 .(3.09 – 22.40)

• VMA – 2mg/24 hrs (N <13.6mg/24hrs).

• FSH , LH – < 0.66m IU ,< 0.21m IU (dec).

• Prolactin – 40.50ng/ml (N 4.79 – 15.2ng/ml)

• Testesterone - 501ng/dl (N 8.4 -48.1)

• Free testesterone 17.08ng/dl (N 0.12 -1.12)

• Bioavailable testesterone 355.87ng/dl (N 2.30 – 26.8)

• SHBG 13.68 (N 40 – 120nmol/l)

• DHEA SULPHATE >1000mcg/dl (N 12 – 379)

• US ABD – large irregular hypodense solid mass lesion arising from the Right adrenal gland m 12X8X7 cm. Right kidney pushed down by the mass .kidneys are normal. No LN

• MRI & CECT – HTN pt with right cerebellar infarct and right adrenal mass

? pheochromocytoma

• Right Adrenelectomy done

• Wt 250 gms

• Sp 11X8X7cms

• E/S – well encapsulated , nodular , ?breach

• C/S – heterogenous ,11X8X7cm , g/br –g/w -

yellowish

INHIBIN

MELAN A

EMACHR

Ki67

• IHC

INHIBIN - POSITIVE

MELAN A – POSITIVE

CHR – NEGATIVE

EMA - NEGATIVE

• Cytology Diagnosis: Adrenal cortical carcinoma / pheochromocytoma

• Cell Block: Adrenal cortical carcinoma

• HPE : Adrenal cortical carcinoma - Right adrenal

• D/D

ACC /Adenoma

Pheochromocytoma

HCC

RCC