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Objective To explore the clinicopathologic features,diagnosis,treatment and prognosis of ACTH-independent subclinical Cushing syndrome caused by cortisol-secreting and hypo-androgen black adrenal cortical adenomas with lipomatous metaplasis.Methods The clinical and pathologic features of 1 patient presented with hypo-androgen and atypical signs and symptoms of Cushing syndrome were reported.The patient's 24 h UFC (235.62 μg) was higher than normal range,his plasma ACTH concentrations (＜1.1 pmol/L,was lower than normal range and his serum cortisol concentrations lacked diurnal rhythm.There was absence of serum cortisol suppression in overnight dexamethasone suppression tests.Serum levels of androgens (1.2 nmol/L) were lower than normal range.24 h urine catecholamine was normal,NE was 160.5 nmol/24 h (5-591 nmol/24 h),E was 23.1 nmol/24 h (0-82 nmol/24 h),DA was 1496nmol/24 h (424-2612 nmol/24 h).Aldosterone lying and standing test:ALD1 138-415 pmol/L,AT-Ⅱ1 64.54 ng/L,PRA1 0.80 μg · L-1 · h-1 Abdomen CT showed right adrenal mass (3.1 cm).131Ⅰ-MIBG scanning was normal.Adrenocortical carcinoma was considered as a possible diagnosis based on cortisol hypersecretion,hypo-androgen and the imaging characteristics.This patient accepted laparoscopic adrenal adenoma resection.Results The adrenal tumor size was 3.5 cm.Immunohistochemical (IHC) staining showed Melan-A,CgA,α-inhibin and Syn positive and Ki-67 ＜ 1％.Histopathologic results showed black adrenal cortical adenomas with myelolipomatous change.After surgery,patient's serum androgen was normal,and the signs and symptoms of Cushing syndrome and oligo-androgen disappeared.There was recurrence after 1.5 years follow-up.Conclusions Although most patients with corticotropin-independent Cushing syndrome associated with abnormal androgen proved to have adrenocortical carcinoma,the clinician should be aware of the possibility of benign,black adrenal adenoma.
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Objective To explore the clinical features, treatment and prognosis of mucinous tubular and spindle cell carcinoma of the kidney. Methods Patient 1, a 42-year-old woman presented with space-occupying lesion of the lower pole of the left kidney with no symptoms in physical examination for 1 week. CT revealed a low-enhanced tumor located in the lower pole of the left kidney in cT1b N0M0. Radical left nephrectomy was performed. Patient 2, a 76-year-old woman presented with space-occupying lesion of the middle of the left kidney with no symptoms in physical examination for 10 d. CT revealed a low-enhanced tumor located in the middle of the left kidney in cT1b N0 M0. Laparoscopic radical left nephrectomy was performed. The patient received adjuvant treatment with IL-2 and interferon-α 3 months after nephrectomy. Patient 3, a 50-year-old woman presented with lumbago for 3 months. CT revealed a low-enhanced tumor located in the right kidney in cT2 N0 M0. Radical right nephrectomy was performed. The patient received adjuvant treatment with IL-2 and interferon-α 3months after nephrectomy. Patient 4, a 60-year-old woman presented with lumbago and hematuria for 15 d. CT revealed a low-enhanced tumor located in the lower pole of the left kidney in cT1a N0M0.Radical left nephrectomy was performed. Results Histological examination of the tumors showed that they consisted of spindle cells arranged in tubular and trabecular patterns embedded in a myxoid stroma. Pathologic diagnosis of all 4 patients were MTSCCa. There was no evidence of recurrence in all patients for 9- 46 months. Conclusions MTSCCa is a rare low-grade renal cell carcinoma.There is a female predominance. Early surgical excision is the best treatment and the prognosis is relatively good.
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Objective To evaluate subclinical Cushing syndrome cases and to improve the diagnosis.Methods A retrospective analysis was done on the data of 24 subclinical Cushing syndrome cases.Clinical data included clinical manifestations,endocrinal tests,imaging,treatments,light microscopic and electron microscopic results.Results No typical sign of Cushing syndrome was found in these 24 cases.Endocrine tests showed that 24-hour urine free cortisol increased in 18 cases (75%),cortisol rhythm disappeared in 12 cases(50%),high-dose dexamethasone suppression test was not inhibited in 11 cases (46%),and low-dose dexamethasone suppression test (LDDST) was not suppressed in all 24 cases (100%).CT scan showed the average tumor diameter was 3.1(1.8-4.5)cm.Laparoscopic resections of adrenal tumors were performed for all 24 patients.The light microscopic examination of the tumor specimens showed adrenocortical adenoma,and the electron microscopic examination found a greater number of cytoplasmic secretory granules.After 3 months' followup,patient's blood pressure was normal and the normal cortisol rhythm was detected.Conclusions Endocrine tests,especially LDDST,are important for the diagnosis of subclinical Cushing syndrome.Once a clear diagnosis of subclinical Cushing syndrome is established,the patient should be treated with surgery and will have a satisfactory result in both blood pressure control and endocrinal rhythm.
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Objective To study the expression of growth inhibitor gene p33ING1 in bladder transitional cell carcinoma(TCC) and its clinical significance.Methods The expression of p33ING1 was examined in 68 cases(58 men and 10 women) of TCC and 12 cases of normal bladder tissues(controls) by immunohistochemistry method.The mean age of the 68 cases at diagnosis was 65 years.The pathological grading showed grade Ⅰ in 16 cases,Grade Ⅱ in 22 and Grade Ⅲ in 30.The clinical staging showed T_1 in 25 cases,T_2 in 17,T_3 in 14 and T_4 in 12.Of the 68 cases,47 developed relapse.Results The p33ING1 was strongly expressed in all the 12 cases of normal bladder tissues with a positive rate of 100%;whereas the overall positive rate of p33ING1 in the 68 cases of bladder carcinoma was 33.8%(23/68).The positive rates of p33ING1 in grade Ⅰ,Ⅱ and Ⅲ cases of bladder carcinoma were 75.0%(12/16),31.8%(7/22) and 13.3%(4/30),respectively;the differences of positive rates between grade Ⅰ and grade Ⅱ,grade Ⅰ and grade Ⅲ cases was significant(P