Case Reports in Endocrinology / 2021 / Article / Tab 3

Case Report

An Uncommon Presentation of Adrenal Cyst with Subclinical Cushing’s Syndrome: A Diagnosis Dilemma

Table 3

Comparative table of the previous cases and the present case.

Clinical presentationLaboratory assessmentCT scanPathology findingsTreatment

Case 1
Nigawara et al., 2009 [15]
Incidental left adrenal mass in a 68-year-old Japanese woman, with obesity and hypertensionSubclinical Cushing’s syndromeLeft adrenal tumor (9 × 7 cm) with highly heterogeneous configuration, including foci of calcification. Contrast media stained only the rim of the tumorVascular cyst with hyaline degeneration (lining cells were CD34 positive) within an adrenocortical adenoma. Immunohistochemical analysis of steroidogenic enzymes showed the expression of P450scc, 3βHSD, P450c17, and P450c21Laparoscopic left adrenalectomy

Case 2
Yamada et al., 2011 [16]
Incidental right renal and left adrenal tumors discovered in a 72-year-old Japanese female, with type 2 diabetes mellitusNormal (nonfunctioning)Right kidney: an enhanced mass, measuring 3 cm × 3 cm. Left adrenal: a well-demarcated nodule measuring 2 cm, consisting of nonenhanced and low-density areasRight kidney: eenal clear cell carcinoma. Left adrenal: association of myelolipoma, endothelial cyst, and adrenocortical adenoma. Immunohistochemical analysis: expression of cytochrome P450c17, 3HβSD, and DHEA-sulfotransferaseRight nephrectomy and left adrenalectomy

Case 3
Hong et al., 2020 [17]
Incidental right adrenal mass in a 53-year-old Chinese man with type 2 diabetesNonfunctioning adrenal massA right circular low-density mass measuring (6 × 7 cm), with a multiroom separation inside the mass. The CT value is 17 HU with no significant enhancement on contrast-enhanced CTCystic mass composed of fibrous wall tissues with local calcification. Another mass with a fibrous capsule outside the cystic wall composed of bright and dark cells, which are arranged in acinar and flaky shapes, and a large, deformed nucleus was present in the foci. Immunohistochemistry shows that the cells stained positive for CD34, D2-40, desmin, and SMALaparoscopic right adrenalectomy

Case 4
The present case
Incidental left adrenal lesion discovered in a 40-year-old woman, with hypertension and obesitySubclinical Cushing’s syndromeA rounded well-defined nonenhancing hypodense lesion of the left adrenal measuring 44 × 29 mm in size, with high spontaneous density, and the absolute washout reached 50% with calcification in the wall which did not enhance after contrast injectionEndothelial cyst within an adrenocortical adenomaLaparoscopic cystic resection and left partial adrenalectomy

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