Metanephrin-producing adrenocortical carcinoma: a case report

Resumen

Adrenocortical carcinoma is a rather infrequent neoplasm that mostly occurs with an autonomous secretion of steroids or steroid precursors. Previous cases have been reported with simultaneous production of metanephrines, but they were associated with intercurrent pheochromocytoma or mixed corticomedular tumors. So far, only two cases of adrenocortical carcinoma that deliver medullar hormones had been published. We herein report a singular case of a 58-year-old man with a finding of an incidental adrenal mass that demonstrated metanephrine production in the hormonal study. Consequently, initial diagnosis of pheochromocytoma was established. Microscopic examination showed an adrenal mass with marked pleomorphism and frequent mitosis. Large areas of coagulative necrosis were interspersed within the tumour. After immunohistochemistry staining there was a high expression of Ki67 (>70%) showing highly proliferative behaviour.  Both cytokeratin AE1/AE3 and vimentin were positive, synaptophysin and chromogranin were negative. The surgical margins were free. Given these features, a diagnosis of metanephrin-producing adrenocortical carcinoma was done.