PTU - Polskie Towarzystwo Urologiczne
list of articles:

CODE: 1 - Suprarenal tumor (oncocytoma) - case report
Article published in Urologia Polska 2006/59/Suplement 1.


Patryk Gmerek
ZOZ MSWiA im. Ludwika Bierkowskiego w Poznaniu


Introduction. The tumors with eozynophilic cells (oncocytic cells) of the adrenal cortex are rare. Only 27 cases have been reported in world literature up till now. Oncocytoma tumors are typical for the salivary gland and for the thyroid gland. Also several cases of the kidney onco-cytoma have been reported. These tumors are composed exclusively or almost exclusively of large, well differentiated, eosynophilic granulation cells with small atypia. The variety of on-cocytic cells, nuclear atypia and mitotic figure may be a sign of malignance. These tumors are usually well separated and they incidentally give metastases to lymphatic nodes (2%) and distant organs.
Objectives. This study is a case report, it's purpose is to estimate the long-term results of the treatment in comparison to world literature.
Materials and methods. 51 years old man was admitted in 2004 to the Urological Ward be-cause of the tumor of right suprarenal gland. The suprarenal tumor was identified in the ultra-sound scan. Computer tomography examination was performed respectively. The CT revealed well separated, inhomogeneous mass, 7.7 cm on 6.6 cm localized above the upper pole of the right kidney, in the localization corresponding to the right suprarenal gland. The lesions den-sity increased after contrast medium administration. The left kidney was of correct size and shape, without focal abnormalities. The size of the left suprarenal gland was correct. There were no other pathological lesions found in the computer tomography. Surgical procedure on the right suprarenal gland was performed. The aim of the operation was to divide the tumor located above the upper kidney pole. The tumor was well demarcated and had it's own cap-sule. During the operation the 7 cm in diameter tumor could be removed without rupture of the capsule. There was no harm made to the right kidney.
Results. The histopathological examination was performed. Histologic sections showed: Oncocytoma cortitis glandulae suprarenalis. Tumor, which was 7 cm in largest dimension, was completely separated and had clear polimorphic features and no mitotic activity. The tu-mor size and it's polimorphic cell structure require careful follow-up. The control computer tomography was performed after 4 months; diagnosis: state after excision of the right supra-renal gland. The size of left suprarenal gland was correct. The kidneys were of correct size, shape and cortex width. The renal vessels in CT were correct. The features of calyco-pelvical stones were not identified. The rest of abdominal organs were without focal lesions in computer tomography. Few periaortic lymphatic nodes were 7 mm in their maximal diameter.
Conclusions. While the level of malignancy of the suprarenal tumor is established only on the basis of the tumor size in computer tomography before the operation, the more common kidney oncocytoma may be diagnosed by angiography (it demonstrates the radial structure of blood vessels) before operation. In case of the suprarenal tumors angiography is not performed. Although the oncocytoma of the suprarenal gland is a quite rare neoplasm it should always be taken into consideration while diagnosing kidney tumors, particulary larger than 7 cm.