case report
Giant adrenal germ cell tumour in a 59-year-old woman
Lei Chen, MD; Lu Fang, MM; Zhiqi Liu, MM; Dexin Yu, MD; Daming Wang, MM; Yi Wang, MD;
Dongdong Xie, MD; Jie Min, MD; Demao Ding, MD; Tao Zhang, MD; Ci Zou, MD; Zhiqiang Zhang, MM
Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, China
Cite as: Can Urol Assoc J 2016;10(5-6):E201-3. http://dx.doi.org/10.5489/cuaj.2904
Published online May 12, 2016.
poorly defined solid mass measuring 7.6 × 6.7 × 9.0 cm on
the right adrenal gland (Fig. 1A). The chest CT showed right
pleural effusion. Moreover, the thoracic drainage device was
closed. There were no tumour cells in pleural effusion. A
successful right adrenalectomy was thus performed on the
patient. Observed by the naked eye, we partially circum-
scribed and encapsulated the excised tumour with maximum
measurement of 9.0 cm. On the cut section, it had a uniform,
yellowish, solid and partially nodular appearance within the
cystic necrosis area.
Histologically, the tumour consisted of diffuse sheets,
alveolar aggregates, and cords of incohesive round monot-
onous cells. These cells contained moderate amounts of
eosinophilic granular cytoplasm and eccentrically located
large round nuclei with prominent nucleoli. Cords of tumour
cells were separated by fine connective tissue septa contain-
ing many lymphocytes (Fig. 2A). On immunohistochemical
staining, the tumour cells were positive for human placental
lactogen (Fig. 2B), c-kit, Vim, CEA, CgA, S-100, CD117 and
alpha-fetoprotein (weakly positive), but negative for EMA,
Syn, CD20, CD30, placental alkaline phosphatase, CK7,
CK2, and a-inhibin. These results confirmed a final diag-
nosis of mixed GCT with dysgerminoma and embryonal
carcinoma.
Abstract
Adrenal germ cell tumour is very rare. We report a case of a
5
9-year-old woman who presented with right flank discomfort.
The laboratory examinations were normal and the chest computed
tomography (CT) showed right pleural effusion. The abdominal
CT scan revealed a large mass on the right adrenal gland. The
patient underwent an adrenalectomy. Histopathologic examination
and immunohistochemical findings were consistent with mixed
germ cell tumour. Three months later following the operation, the
patient was admitted to our hospital again with chest tightness and
shortness of breath. The chest CT showed right pleural effusion
recurrence and enlargement of mediastinal lymph nodes and right
hilar lymph nodes. The patient had right supraclavicular lymphad-
enectasis on physical examination. Fine needle aspiration cytology
from the supraclavicular lymph nodes showed groups of malignant
tumour cells. The patient died within 6 months postoperatively.
In this case, the lymph node pathway played an important role in
the metastatic procedure.
Introduction
Initially, the tumour was considered metastatic.
Postoperative ultrasonography, pelvic CT scan, however,
showed no abnormal findings in the bilateral ovaries. The
patient’s serum concentrations of the tumour markers, such
as alpha-fetoprotein (16 ug/L), CA-125 and carcinoembry-
onic antigen, were within normal ranges. Chemotherapy
was recommended, but the patient refused it.
Extragonadal germ cell tumours (GCTs) are uncommon and
1
,2
represent 2% to 5% of adult germ cell malignancies. The
histogenesis of extragonadal GCT is unknown. We present
an extremely rare case of an adrenal mixed GCT composed
of dysgerminoma and embryonal carcinoma. To our knowl-
edge, this is the first report of GCT in the adrenal gland.
Three months after the operation, the patient presented to
the respiratory department with a three-day history of chest
tightness and shortness of breath. The computed tomography
scan revealed a large amount of pleural effusion on the right
side and enlargement of mediastinal lymph nodes and right
hilar lymph nodes (Fig.1B). On physical examination she
had right supraclavicular lymphadenectasis. Subsequently,
Case report
A 59-year-old woman was admitted to hospital with a four-
month history of right flank discomfort. Physical examinations
and laboratory findings were normal. An abdominal comput-
ed tomography (CT) scan revealed a large, heterogeneous,
CUAJ • May-June 2016 • Volume 10, Issues 5-6
2016 Canadian Urological Association
E201
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