Adrenal Cortical Adenoma in the Spinal Canal: A Case Report and Review of the Literature.

Ectopic adrenal cortical neoplasms of the spinal cord are extremely rare. To date only 10 such cases have been described. We present a case of a 46-year-old woman with lower back pain radiating to the right gluteal and posterior femoral regions, without a history of traumatic injury. Magnetic resonance imaging (MRI) of the thoracic and lumbar spine showed an intradural, extramedullary, well-circumscribed, contrast-enhancing lesion located in the T12-L1 region, hypo- to isointense on T2-weighted imaging, and isointense on T1. Complete surgical removal of the lesion, measuring 3 × 2.5 × 1 cm, was performed. The histopathologic findings revealed the lesion was an ectopic adrenal cortical adenoma, with sheets and nests of round and polygonal cells, mostly round regular nuclei, abundant eosinophilic cytoplasm, 1 mitosis per 10 high-power fields, and without necrosis. These tumors have nonspecific MRI features and therefore can be easily confused with other common spinal tumor types such as ependymoma, schwannoma, meningioma, and metastasis. Although rare, ectopic adrenal spinal cord adenomas should be taken into account in the differential diagnosis of spinal canal intradural neoplasms.

Malignant brain neoplasms incidence and mortality trends in Croatia from 2001 to 2014.

AIM: To analyze the sex-specific incidence and mortality trends of brain malignancies in Croatia from 2001 to 2014. METHODS: Incidence and mortality rates per 100000 population were calculated using data obtained from the Croatian National Cancer Registry and the Croatian Bureau of Statistics. Rates were age-standardized to the European Standard Population, and trends were assessed using joinpoint regression. RESULTS: In the observed period there were 6634 new brain malignancy cases (52% men) and 5379 deaths due to this diagnosis (52% men). Age-standardized incidence rates ranged from 9.2-11.5 per 100000 in men and from 7-8.8 per 100000 in women. Mortality rates ranged from 7.5-8.7 per 100 000 in men and from 5-6.5 in women. Incidence trends in men, mortality in men, and mortality in women were not statistically significant, while a significant trend was observed in incidence in women (annual percent change -1.5; 95% confidence interval -2.3 to -0.6). No joinpoints were observed in any of the joinpoint analyses by sex for incidence and mortality. Age-specific incidence and mortality rates in both sexes indicate a trend shift toward older age. The proportion of morphologically verified cases ranged from 40.2%-62.4% in men and from 38.6%-56.3% in women; the proportion of death-certificate-only cases ranged from 3.3%-9.4% in men and from 3.3%-17.5% in women. CONCLUSION: Incidence and mortality of brain malignancies in Croatia are among the highest in Europe, while reporting on brain malignancies is still poor. There is a need for improved care of patients with brain malignancies and detailed and accurate data reporting.