4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta
4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta
4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta
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Clinical Cytology - Oral Presentations<br />
FINE NEEDLE ASPIRATION CYTOLOGY OF ADRENOCORTICAL CARCINOMA:<br />
CASE REPORT<br />
Mišić M1 , Vidas Ž2 , Škegro D3 , Kocman B4 , Jelić-Puškarić B5 , Kardum-Skelin I5 1 General Hospital “Dr. J. Benčević”, Department of Cytology, Slavonski Brod<br />
2 University Hospital Merkur, Division of Urology, Zagreb<br />
3 University Hospital Merkur, Department of Medicine, Zagreb<br />
4 University Hospital Merkur, Department of Surgery, Zagreb<br />
5University Hospital Merkur, Department of Medicine, Laboratory for Cytology and Hematology,<br />
Zagreb, Croatia<br />
Adrenocortical carcinoma (ACC) is a malignant epithelial tumour of adrenal cortical<br />
cells. Approximately half of all ACCs are hormonaly functional. A 49-year-old woman<br />
presented for hirsutism, deep voice and hypertension. Ultrasonography (US) revealed a<br />
solitary tumor mass, 8 cm in size, of the right adrenal gland. Laboratory tests showed<br />
it to be a hormonally active, androgen secreting tumour (elevated testosterone level),<br />
which was consistent with the clinical picture of the disease. After histopathologic analysis<br />
tumor was signet out as adrenocortical carcinoma, a low risk carcinoma according<br />
to Weiss’ classification. On regular follow up US study performed at one year, a 65x43<br />
mm growth was diagnosed in the lower pole of the right kidney. The finding was verified<br />
by computerized tomography and the patient was reoperated on. Exploration revealed<br />
secondary growth in the region of greater omentum, without infiltration of adjacent organs.<br />
Histopathologic analysis confirmed metastatic ACC. At 8 months of the second<br />
operation and after 6 chemotherapy cycles according to EAP protocol, enlarged paraaortic<br />
lymph nodes and a node along the upper pole of the right kidney were diagnosed<br />
by cytologic puncture. Cytologic analysis showed numerous large tumor cells (individual<br />
and in papillary clusters) with polymorphic, hyperchromic, irregular nuclei, prominent<br />
nucleoli with perinucleolar halo, and abundant pale basophilic cytoplasm. The cells<br />
were positive for vimentin, NSE, synaptophysin and epithelial markers (BerEP4 and epithelial<br />
membrane antigen - EMA). ACC is a rare tumor of high malignant potential. Morphologically<br />
(histopathology and cytology), there is the problem of differential diagnosis<br />
from adenoma on the one hand, and from renal cell carcinoma (RCC) and hepatocellular<br />
carcinoma (HCC) on the other hand. A combined evaluation of clinical features , size or<br />
weight, microscopic appearance, immunohistochemical and molecular genetic data is<br />
necessary.<br />
maja.misic1@gmail.com<br />
95<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology