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Case Report
The paradox of size: A case of indolent oncocytic adrenocortical carcinoma and review of literature
1 Department of Internal Medicine, The University of Texas at Austin, Austin, TX, USA
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Sujata Ojha
Department of Internal Medicine, The University of Texas at Austin, Austin, TX,
USA
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Article ID: 100151Z10SO2025
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Ojha S, Abdullah Y, Pandey ON, Goodgame B, Kumar P, Kulkarni M. The paradox of size: A case of indolent oncocytic adrenocortical carcinoma and review of literature. J Case Rep Images Oncology 2025;11(2):20–24.ABSTRACT
Introduction: Oncocytic adrenocortical carcinoma (OAC) is a rare histologic variant of adrenocortical carcinoma. It is characterized by cells with abundant eosinophilic cytoplasm because of high mitochondrial content. Unlike conventional Adrenocortical carcinoma (ACC), which is typically aggressive, OAC often presents with a more indolent biological behavior. The paradoxical features of OAC make the diagnosis and management challenging.
Case Report: A 45-year-old female presented with weight loss and left-sided abdominal pain, with initial imaging revealing a large (24 cm) left adrenal mass. Imaging revealed that the mass had radiologic signs and necrotic features concerning for malignancy. She subsequently underwent a left adrenalectomy with en bloc pancreatectomy, splenectomy, and left nephrectomy along with paraaortic lymphadenectomy. Histopathology revealed classic oncocytic morphology with low Ki-67 index (2%) and absence of any lymph node involvement, despite venous and capsular invasion. Due to the venous invasion alone, the tumor met the Lin–Weiss–Bisceglia (LWB) criteria for malignancy. Additional molecular analysis revealed a favorable diagnosis by showing TP53 alterations, low tumor burden, along with microsatellite stability. Postoperatively, the patient recovered and was administered external beam radiation.
Conclusion: This case is an example of a rare subtype of ACC and highlights a clinical paradox. In patients with OAC, a large tumor size with necrosis may not always be associated with a poor prognosis. Additionally, OAC has unique diagnostic and management challenges due to its rare nature. However, surgery is still the mainstay treatment for OAC, with the role of mitotane in adjuvant therapy still being explored.
Keywords: Adrenal cortical carcinoma, Adrenal tumor, Lin–Weiss–Bisceglia, Oncocytic adrenocortical carcinoma
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Acknowledgments
Artificial Intelligence, ChatGPT 4.0, was utilized for grammar and language refinement. AI-generated data or results are not included in this manuscript. All scientific interpretations are completed by the authors.
Author ContributionsSujata Ojha - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Youssef Abdullah - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Om Narayan Pandey - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Boone Goodgame - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Pratima Kumar - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mrinalini Kulkarni - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Sujata Ojha et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
