Table 1. Preoperative elevated cortisol levels with loss of
diurnal rhythm, postoperative restoration of cortisol secretion rhythm.
Based on the patient’s clinical manifestations, hormonal test results,
and imaging findings, the diagnosis included: ectopic adrenocortical
adenoma, ACTH-independent Cushing’s syndrome, hypertension, and
nonfunctioning right kidney. After confirming the diagnosis, the patient
underwent robot-assisted laparoscopic resection of the ectopic
adrenocortical adenoma at the left renal hilum under general anesthesia
on July 11, 2024.
4. OUTCOME AND FOLLOW-UP
Intraoperatively, the tumor was located in the renal sinus, closely
associated with the kidney, lacking an intact capsule, and adhered
tightly to the renal hilar vessels. Some venous tributaries of the tumor
drained into the left renal vein. The left renal artery was clamped
intraoperatively to facilitate tumor resection. The tumor was completely
removed, with a warm ischemia time of 20 minutes (Fig. 4 A, B).
Postoperative pathology confirmed the diagnosis of an adrenocortical
adenoma (Fig. 4 C). Immunohistochemistry results: CA9(-), CD10(focal+),
CD117(-), CK(-), CK7(weak, scattered+), GATA3(-), Heppar-1(weak,
scattered+), HMB45(-), Ki-67(+5%), Melan A(+), Pax-8(-), S100(-),
SDHB(+), TFE-3(partial+), Vimentin(partial+), a-inhibin(+), Calponin(-),
CD34(vessels+), Desmin(-), MPO(partial+), SMA(-), EMA(-).