Virilizing Adrenal Oncocytoma
A 16-year-old girl presented with a 6-month history of primary amenorrhea and pain in the abdomen. She also noticed excessive facial hair growth during the 6-month period. The weight of the patient was 55 kg. The height was normal for her age. She had normal secondary sexual development. There was male pattern of hair distribution []. Breast development was Tanner Stage IV. Pubic hair development was Tanner Stage V. Clitomegaly was present. Uterus and adenexa were normal on per rectal examination. Her blood pressure was normal and there was no diabetes mellitus. The total testosterone level was raised and value was 435 ng/dl (normal range, 14-76 ng/dl). Dehydroepiandrosteronesulfate (DHEA-S) level was >1500 μg/dl (normal range, 61-493 μg/dl). Vanillylmandelic acid (VMA) level was 10.10 mg/24 h (normal range, <15.0 mg/24 h). Rest of the blood parameters were normal.\nComputed tomography (CT) scan of the abdomen was performed on a 64-slice multidetector MDCT scanner (GE light speed VCT XTe whole body 64 slice CT system from Wipro GE Healthcare Private Limited). On noncontrast CT scan, there was a well-defined hypodense mass of size 11.6 × 10.7 × 12 cm, with scattered areas of calcifications. Center of the mass showed a stellate shaped noticeably hypodense area. Plain CT attenuation was around 59 HU. Arterial phase scan (acquired at 30 s) showed a tangle of serpiginous, thin intratumoral vessels throughout the mass except in the central stellate nonenhancing area []. These vessels gave a can-of-worms like appearance on volume rendered images []. The periphery of the mass was supplied by dilated, thick, tortuous vessels arising from phrenic and renal vessels []. The average postcontrast attenuation of the mass was around 70HU. It had a thin intensely enhancing capsule. In the venous phase scan (acquired at 60 s), the mass showed homogenous enhancement except for the central nonenhancing area []. The values were in the range of around 103 HU. The right kidney was pushed inferomedially by this mass. The fat planes with liver were maintained. There was no lymphadenopathy or ascites. Big vessels were normal.\nOpen right adrenalectomy was performed. The tumor was round in shape and well encapsulated []. It was highly vascular and had blood supply from the aorta, renal, and phrenic vessels. The histopathological examination showed oncocytic cells with eosinophilic cytoplasm and small round nuclei. There was no mitosis. Necrosis was seen in the smears []. The final diagnosis was testosterone secreting adrenocortical oncocytoma. The recovery was uneventful and features of virilization receded in follow-up done after 3 months.