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(-).