RARE CASE OF MYELOLIPOMATOUS METAPLASIA WITHIN AN ADRENOCORTICAL ADENOMA

The actual incidence of adrenocortical adenoma (ACA) remains unknown. Data obtained from 2011 to 2015 in Cipto Mangunkusumo Hospital have revealed that only 14 patients presented with adrenal neoplasms; of these patients, 11 were diagnosed with ACA. Myelolipomatous metaplasia is characterized by the presence of foci of hematopoietic cells comprising erythroids, myeloids, and megakaryocytes within a tumor. This metaplasia is an extremely rare finding in adrenal tumors, particularly in ACA. The pathogenesis of myelolipomatous metaplasia remains unclear. Herein, we report the case of a 40-year-old man who presented with a mass in his abdomen. Without any contributory signs and symptoms, the size of the mass increased within 4 months of diagnosis. Computed tomography of the abdomen showed a heterogenous mass in the right suprarenal region with fine demarcated outlines, and the result was indicative of an adrenal carcinoma. The patient underwent adrenalectomy. Based on hematoxylin &eosin (H&E) staining and immunohistochemical analysis, the mass was confirmed to be a nonfunctional ACA with a myelolipomatous metaplasia. The case was uneventful, and the patient was then discharged with recommendation of an annual follow-up. ACA is a rare type of tumor. Myelolipomatous metaplasia found within an adenoma of the adrenocortex is an even more uncommon finding. The correlation between clinical, radiological, and pathological examination results must be assessed for a more accurate diagnosis. The combination of H&E staining and immunostaining is helpful in facilitating the diagnosis of adrenocortical tumors and metaplasia within the tumor.