Bilateral adrenocortical adenomas causing adrenocorticotropic hormone-independent Cushing’s syndrome: A case report and review of the literature

Figure 1 Abdominal computed tomography images. Abdominal computed tomography images show bilateral adrenal adenomas with atrophic adrenal glands. Arrows indicate tumors with a low density (right, 3.1 cm × 2.0 cm × 1.9 cm; left, 2.2 cm × 1.9 cm × 2.1 cm). Tumors are homogeneously enhanced in the presence of contrast material.

Figure 2 Histological characteristics of the adenomas (Hematoxylin-eosin staining). A-D: The left (A: ×40, B: ×100) and right (C: ×40, D: ×100) adenomas comprised both clear cells and compact cells.

Figure 3 Immunohistochemical staining of the left adrenal adenoma (×100). A and B: Areas negative for chromogranin A (CgA) (A) and cytokeratin (CK) (B); C-E: Tumor cells exhibiting strong staining for inhibin (C), synaptophysin (Syn) (D), and MelanA (E); F and G: Most parts of the tumor showed a proliferation index < 2% (F) and spotty positivity for S100 (G).

Figure 4 Immunohistochemical staining of the right adrenal adenoma (×100). Areas negative for chromogranin A (CgA) (A) and cytokeratin (CK) (B), where some tumor cells exhibited positive staining for inhibin (C), synaptophysin (Syn) (D), and MelanA (E). Most parts of the tumor show a proliferation index < 2% (F) and spotty positivity for S100 (G).

Figure 5 The timeline of this case report.