Asymptomatic bilateral giant adrenal myelolipomas: case report and review of literature.

OBJECTIVE: To describe an unusual case of bilateral giant adrenal masses caused by a primary adrenal myelolipoma. METHODS: We present the clinical, laboratory, and pathologic findings in a 32-year-old man with bilateral adrenal masses. The previous reports of bilateral myelolipomas also were reviewed. RESULTS: During a routine examination, a 32-year-old Thai man was found to have an asymptomatic abdominal mass. A computed tomographic scan of the abdomen disclosed bilateral adrenal masses; the one on the left was approximately 27 by 24 by 12 cm, and the one on the right side was 9 by 5 by 5 cm. The computed tomographic scan characteristics showed that both masses consisted mainly of low-density tissues (-30 to -90 Hounsfield units), suggestive of fatty component. An endocrinologic evaluation revealed no evidence of adrenal cortical or medullary functional abnormalities. Bilateral adrenalectomy was performed because of the large size of the lesions and the inability to rule out malignant involvement. CONCLUSION: Myelolipoma is a relatively rare benign tumor of the adrenal glands composed of adipose cells and mature hematopoietic elements. Most such lesions are small, asymptomatic, and unilateral; giant or bilateral myelolipomas are quite rare. To our knowledge, our current case may represent the largest bilateral lesions in the literature.

Functioning adrenocortical carcinoma with superior vena cava and upper airway obstructions.

BACKGROUND: Adrenocortical carcinoma (ACC) is one of the most aggressive endocrine malignancies with a dismal prognosis. Typically, the tumor is large and has regional invasion or distant metastasis at initial presentation. OBJECTIVE: To describe an unusual case of functioning ACC presenting with superior vena cava (SVC) and upper airway obstruction. MATERIAL AND METHOD: A 23-year-old man with cushingoid appearance was evaluated for a neck mass and SVC syndrome. Hormonal assessment and neck mass biopsy including immunohistochemistry study were performed RESULTS: Cushing's syndrome was confirmed by elevated 24-hr urinary free cortisol and no suppressible cortisol level after standard low dose (2 mg/day) of dexamethasone suppression test. Computerized tomography (CT) study revealed a huge left suprarenal mass and multiple mediastinal lymph nodes compressing SVC and trachea. Histopathological findings of the neck mass were compatible with metastatic ACC. CONCLUSION: The present report describes a functioning ACC patient with an unusual metastatic site causing SVC and upper airway obstruction. His hospital course was progressively worsened due to peptic perforation and decompensated respiratory failure, which led him to expire.

Integrated criteria of fine-needle aspiration cytology and radiological imaging for verification of breast cancer in nonpalpable lesions.

OBJECTIVES: To evaluate the accuracy of using radiologic, cytologic and integrated radiologic and cytologic criteria in diagnosis of nonpalpable breast lesions. MATERIAL AND METHOD: From January 2003 to May 2004, a prospective study of performing fine-needle aspiration biopsy (FNAB) was carried out at King Chulalongkorn Memorial Hospital on female patients with nonpalpable or vaguely palpable lumps that needed ultrasound localization for the direction and depth. RESULTS: There were 162 lesions from 150 patients, consisting of 29 malignant neoplasms (17.9%) and 133 benign lesions (82.1%). Of the 107 classified as subcentimeter focal lesions (< 1 x 1 cm2 in size), two of radiological malignancy were false and two others were falsely negative by cytology. While the 23 large/ill-defined lesions (> 1.5 x 1.5 cm2 in size), one hiding malignant lesion adjacent to a prominent intraduct papilloma was missed. Two others had falsely negative cytologic diagnosis. The integrated criteria achieved accuracy and sensitivity of 97.5% and 93% compared with the cytology, 96.3% and 82.8% and the better scenario of radiology, 95.7% and 82.8% respectively. CONCLUSION: The integrated criteria provide the most accuracy rate and sensitivity rate for detection of malignancy in nonpalpable breast lesions.

Abnormal findings in breast imaging: a hospital-based survey in 4264 Thai women.

OBJECTIVE: To evaluate the distributions of common and significant imaging findings from breast imagings at King Chulalongkorn Memorial Hospitals. MATERIAL AND METHOD: Data was collected from every mammography performed from November 1, 2001 to October 31, 2002. The reports were analyzed and imaging findings were recorded. The ACR BI-RADS category was applied to all cases. RESULTS: There were 4264 patients and all of them were female. The age range was between 19-90 years and average age was 50.1 years. The most common positive findings were cysts (39.22%), followed by focal lesions (14.76%), mass (8.69%), architectural distortion (7.83%), calcification (7.36%) and thick ducts (3.76%). According to ACR BI-RADS, most of the studies were in category 2 (42.59%), followed by category 1 (38.67%), category 3 (12.08%) category 5 (3.45%), category 4 (3.12%) and category 0 (0.09%). CONCLUSION: Breast imaging is the standard screening tool for breast cancer and can reveal different kinds of findings. Knowing the distribution of these findings helps both the radiologists to understand the scope of their work and the institution to audit their practice.

Role of combined fine needle aspiration and ultrasonography in the diagnosis of impalpable lesions of the breast.

OBJECTIVE: To evaluate the efficacy of combined fine needle aspiration (FNA) and ultrasonography in the diagnosis of impalpable breast lesions. METHOD: To analyze the diagnostic performance of the FNA cytology and ultrasound among female patients with impalpable breast lesions that were referred to the FNA clinic at King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University in Bangkok, Thailand during the period of July 2001 to June 2002. The final diagnoses employed surgical pathology and 6-month follow-up of the patients. RESULT: In a-year-period of the studied frame, there were 57 studied cases (18.3% of the total FNA breast cases). To diagnose malignant lesions, FNA cytology achieved the sensitivity of 61 per cent and the specificity of 100 per cent, whereas, diagnostic radiology had a sensitivity of 100 per cent and specificity of 56.1 per cent. The FNA cytology was superior to ultrasound in the determination of inflammatory lesions while imaging was dominant in the hard-to-aspirate malignant lesions. Therefore, the combined cyto-radiology criteria could correctly diagnose malignancy in all cases (100% accuracy). CONCLUSION: The efficacy of combined FNA and ultrasonography in the diagnosis of impalpable breast lesions was highly satisfactory. The accuracy of each technique enhanced each other and gave the correct diagnosis in all cases.