A case of a borderline adrenal oncocytoma in a 62-year old female.

INTRODUCTION: Adrenal oncocytomas are a rare pathology and only about 160 cases have been reported in the literature. CASE DESCRIPTION: We describe the case of a 62-year old female with an incidentaloma found in the right adrenal gland on a CT scan. Endocrine testing showed a non-secreting lesion. An MRI was performed to get a more precise diagnosis. It excluded a simple adenoma and a malignant tumor had to be suspected. Open adrenalectomy was performed, and pathology results confirmed a borderline adrenal oncocytoma. DISCUSSION: Oncocytomas are usually found in the kidneys, salivary glands, parathyroid, lung, pituitary gland, and ovaries. It is important to differentiate them from, for example, pheochromocytomas, adrenal cortical carcinoma, and metastasis. Most oncocytomas are non-functioning (17% are functional). Usually, they are found as incidentalomas on a CT or MRI scan. The only way to confirm the diagnosis at present is pathological examination. Bisceglia and his colleagues have proposed a new system to classify adrenal oncocytomas. The presence of one major criterion indicates malignancy, the presence of one to four minor criteria is indicative of uncertain potential. The absence of all major and minor criteria indicates benign behavior. Treatment options are open surgery, laparoscopic surgery and rarely robotic surgery. CONCLUSION: An adrenal oncocytoma remains a rare diagnosis and has a wide array of differential diagnosis. It should be treated by surgical removal and a close follow up is suggested. More research should be done regarding diagnosis, treatment and follow-up.

Skin lesions in European hibernating bats associated with Geomyces destructans, the etiologic agent of white-nose syndrome.

White-nose syndrome (WNS) has claimed the lives of millions of hibernating insectivorous bats in North America. Its etiologic agent, the psychrophilic fungus Geomyces destructans, causes skin lesions that are the hallmark of the disease. The fungal infection is characterized by a white powdery growth on muzzle, ears and wing membranes. While WNS may threaten some species of North American bats with regional extinction, infection in hibernating bats in Europe seems not to be associated with significant mortality. We performed histopathological investigations on biopsy samples of 11 hibernating European bats, originating from 4 different countries, colonized by G. destructans. One additional bat was euthanized to allow thorough examination of multiple strips of its wing membranes. Molecular analyses of touch imprints, swabs and skin samples confirmed that fungal structures were G. destructans. Additionally, archived field notes on hibernacula monitoring data in the Harz Mountains, Germany, over an 11-year period (2000-2011) revealed multiple capture-recapture events of 8 banded bats repeatedly displaying characteristic fungal colonization. Skin lesions of G. destructans-affected hibernating European bats are intriguingly similar to the epidermal lesions described in North American bats. Nevertheless, deep invasion of fungal hyphae into the dermal connective tissue with resulting ulceration like in North American bats was not observed in the biopsy samples of European bats; all lesions found were restricted to the layers of the epidermis and its adnexae. Two bats had mild epidermal cupping erosions as described for North American bats. The possible mechanisms for any difference in outcomes of G. destructans infection in European and North American bats still need to be elucidated.