Metastatic Adrenocortical Carcinoma to the Skin: A Case Report and Review of This Unusual Neoplasm.

ABSTRACT: Adrenocortical carcinoma is a very rare oncologic condition with poor prognosis that usually metastasizes to the lungs, liver, local lymph nodes, and peritoneum at initial presentation. However, skin metastasis is very uncommon and has rarely been reported even in advanced stages of the disease. We present a case of a 41-year-old man with a known history of adrenocortical carcinoma of the right adrenal gland that presented with an arm mass. The histopathologic sections showed a multinodular necrotic malignant neoplasm in dermis and subcutaneous fat composed of atypical epithelioid cells with ample granular cytoplasm and pleomorphic vesicular nuclei with frequent intranuclear inclusions and atypical mitoses. The immunohistochemical stains showed tumor cells that were strongly positive for synaptophysin and inhibin, only focally positive for Melan-A, and negative for AE1/AE3. The histopathologic features and the immunohistochemical profile confirmed the diagnosis of metastatic carcinoma consistent with adrenal cortical origin. The diagnosis can be difficult (especially when no clinical data are provided), and an immunohistochemical battery is often useful in distinguishing this tumor from other tumors with similar cytomorphological features.

Diagnostic Imaging Fundamentals: Brain Vascular Pathology.

INTRODUCTION: This module was created to supplement the traditional learning methods that senior medical students, first-year radiology residents, and residents in other specialties employ to learn the fundamentals of radiologic image interpretation. It is part of an ongoing project entitled Diagnostic Imaging Fundamentals (DIF), with each module covering a unique topic. This module covers brain vascular anatomy, common imaging modalities, and imaging characteristics of brain vascular pathologies. METHODS: This module has been designed for team-based learning and consists of advance-preparation reading material, in-class individual and group readiness assurance tests, and a group application exercise. Students are evaluated both individually and as groups. These DIF modules are designed primarily for group learning and are well suited for the academic setting. RESULTS: The feedback we received from first-year radiology residents was 100% positive, and the most frequent remark used by learners in their comments was "very helpful." Our limited feedback suggests that the level of material is appropriate for trainees at or above their final year of medical school. DISCUSSION: We are confident that this module will benefit students and residents who are eager to learn the fundamentals of brain vascular imaging and will serve as a useful adjunct to traditional methods of learning. We believe the module's application of team-based learning can act as a model for collaborative learning in a traditionally didactic learning environment. Future work will include expanding use of the module to larger groups of radiology residents, medical students, and residents in other specialties.