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A small nodule of ectopic adrenal tissue (H&E 40×). The distinct fibrous capsule (C) covers a thin, patchy layer of clumps of cells, the zona glomerulosa (G). The middle and thickest layer is the zona fasciculata (F), composed of columns of cells with a clear or finely vacuolated cytoplasm in which the cells of the zona reticularis (R), with uncharacteristically eosinophilic cytoplasm, lie.
Source publication
Aim: To evaluate 6 cases of inguinoscrotal ectopic adrenal nodules, which were detected in 2 hospitals. Materials and methods: A total of 296 male patients who had inguinoscrotal surgery between 2009 and 2011 were retrospectively evaluated. Bright yellow nodular lesions, resembling the adrenal tissue, were excised during surgery. Histopathologic ex...
Context in source publication
Context 1
... the histopathologic examination, 5 patients were diagnosed with corticoadrenal ectopia, and 1 patient with corticomedullary ectopia. Microscopic photographs of cortical cells and cortical and medullary cells are shown in Figures 2 and 3, respectively. In all 6 cases, 3 layers of adrenal cortex (glomerulosa, fasciculata, and reticularis) were histopathologically shown. ...
Citations
... Indeed, our patient underwent an adrenalectomy. Some reports recommend surgeons to resect lesions suspicious of ectopic adrenal tissue during surgery [14,15], whereas others suggest that it is important to diagnose ectopic adrenal tissue as non-invasively as possible considering that they require no treatment due to their asymptomatic nature [16]. ...
A pheochromocytoma is an uncommon tumor that originates from the chromaffin cells of the adrenal medulla. Also, adrenal tissue not located in its typical position is referred to as ectopic adrenal tissue. It is relatively uncommon in adults and is usually asymptomatic. Therefore, a pheochromocytoma arising from ectopic adrenal tissue is even a rarer finding and presents as a unique diagnostic challenge. A 20-year-old man presented with vague abdominal pain, and upon imaging, a mass located behind the liver was initially discovered. Subsequently, it was identified as a mass growing in an ectopic adrenal gland. He underwent exploratory laparotomy and resection of the mass. A pheochromocytoma in an ectopic adrenal gland was confirmed by histopathology.
... The low rate is thought to be due to atrophy of ectopic tissue in advanced ages. Ectopic adrenal tissue was reported in various parts of the body such as kidney, coeliac area, thorax, liver, brain [6]. In this article, we present a case of ectopic adrenal tissue in inguinal hernia sac, which is rarely seen in adults. ...
... Ketata et al., found ectopic adrenal tissue in 1.66% (n=31) of 1862 patients who underwent inguinoscrotal surgery, and none of them had an adrenal medulla [7]. However, Oguz et al., in 1 of 6 patients, they found the adrenal cortex and adrenal medulla together within the ectopic tissue [6]. ...
Inguinal localization of ectopic adrenal tissue is a rare condition in literature. We report an unusual case of a 28-year-old male patient with ectopic adrenocortical tissue, which was noticed coincidentally as a orangeyellowish nodule during surgery of inguinal hernia and resected for patological examination.
... The observation of adrenal tissue ectopically in other localizations was first described by Morgagni in 1740 (1). Currently, majority of the cases of ectopic adrenal tissue are known to be encountered in the retroperitoneal area, the kidney parenchyma, the celiac plexus, thorax, liver capsule, lungs brain and less often in the spermatic cord, testis and the surrounding tissues (2). ...
... Currently, majority of the cases of ectopic adrenal tissue are known to be encountered in the retroperitoneal area, the kidney parenchyma, the celiac plexus, thorax, liver capsule, lungs brain and less often in the spermatic cord, testis and the surrounding tissues (2). In the literature, it has been noted that the majority, primarily in the pediatric age group, are determined incidentally during surgery (1,3). In contrast to the literature, the case presented here is 35 years old. ...
... They develop in the form of multiple primordial or separately secondary to the main gland. If they are close to the main gland, they include the medulla (1,4). Therefore, the majority of ectopic adrenal tissues seen in the spermatic cord or the epididymis are formed from the cortex section only. ...
Ectopic adrenal tissue is a benign lesion generally determined incidentally during a surgical intervention applied for another reason. This tissue may be present along the path of the testicles and groin discovered during surgery. While the condition has been mainly reported in the pediatric population, it is very rarely reported in adults. The aim of this study was to present an adult patient with ectopic adrenal tissue which was determined incidentally within an indirect inguinal hernia sac.
... Moreover, in their review of the literature until 2006, less Laparoscopic Finding of EAT in a 2-Year-Old Boy with Vanishing Testis Marte e5 than 100 cases were described near the genital structures. 1 Some cases of EAT have also been reported in girls, although the lower incidence in girls is not easy to explain. Oğuz et al, 12 in a multicenter study, reported an incidence of EAT of 2.02% out of a total of 296 male patients who had inguinoscrotal surgery between 2009 and 2011. Vaos et al 13 reported a comprehensive incidence of 2.5% of EAT in 316 inguinoscrotal operations performed on 289 consecutive patients (0.7% in girls and 1.8% in boys). ...
Ectopic adrenocortical tissue (EAT) along the spermatic cord is an unusual condition in children. The author reports on a 2-year-old boy with impalpable testis. On laparoscopy, EAT was detected along the hypotrophic spermatic vessels and excised. These remnants should be removed to prevent hormone production or malignant transformation.
... Literatürde büyük çoğunluğu pediatrik yaş grubunda olmak üzere yaklaşık 150 kadar spermatik kord ve çevresinde ektopik adrenal dokusu bildirilmiş olup bu olgular inmemiş testis,hidrosel, inguinal herni gibi nedenlerle cerrahi uygulanan hastalarda tesadüfen eksplorasyon sırasında farkedilmişlerdir. [2][3][4] Bu olguda ise testis tümörü nedeniyle inguinal orşiektomi uygulanan hastanın spermatik kordunda patolojik inceleme ile rastlantısal olarak saptanan ektopik adrenal dokusu sunulmuştur. Literatürde testis tümörü ile birlikte ektopik adrenal dokusu birlikteliği sadece iki vakada bildirilmiştir. ...
zet Ektopik adrenal doku genellikle başka bir amaçla yapılan cerrahi girişimlerde tesadüfen saptanan benign bir lezyondur. Pediatrik yaş grubunda çok nadir görülen bir durum değildir, ancak testiküler kanser ile birlikteliği yalnızca iki vakada bildirilmiştir. Bu yazımızda biz spermatik kordda ektopik adrenal dokusu saptanan testis tümörü vakasını sunuyoruz. Abstract Adrenal ectopic tissue is a benign lesion which is usually identified incidentally during surgical procedures performed with other purposes. It is not uncommon in pediatric age groups, but its coincidence with testicular cancer has been reported in two cases only. İn our article we present a testicular cancer case in association with ectopic adrenal tissue in spermatic cord. Anahtar kelimeler: Adrenal ektopi, Testis kanseri Orşiektomi
Extended Summary
Objective
To evaluate ectopic adrenal cortical tissue (EACT) and identify clinical, pathological and radiological aspects.
Study Design
Retrospective review of pathology reports in a single tertiary institution between 2010 and 2020 was conducted. Patients diagnosed with EACT were included for analysis. Demographic characteristics, accompanying pathologies and clinicopathological and radiological findings of these patients were analyzed.
Results
There was a total of 17 patients in the cohort. Fifteen were boys and 2 were adults (1 male). The mean diameter of the EACT nodule was 0.25 cm (range 0.2-0.5 cm). All EACTs were incidentally diagnosed. Seven EACTs were diagnosed during an inguinal hernia repair, 6 during orchidopexy, 1 during partial orchiectomy, 2 during orchiectomy and 1 during hysterectomy and bilateral salphingooferectomy due to uterine prolapse.
Discussion
EACT is a rare entity that is mostly found incidentally during inguinoscrotal interventions. Radiological discrimination of EACT may not be easy and thus, not detected prior to surgery. Clinical significance of EACT is not very well understood, however it tends to be benign pathology. Although it is more commonly found in children, adults may present with EACT, as well.
Conclusion
A tiny yellowish nodule detected in the inguinoscrotal region should be suspected for EACT by pediatric urologists, surgeons, and pathologists.
Material and methods
A retrospective analysis of impalpable undescended testis was carried out between May 2016 and June 2019. The demographic data, intra-operative findings and histopathological diagnosis were analyzed. In conjunction with this, systematic search of PUBMED and EMBASE database was performed by using the search terms “undescended testis” AND “ectopic adrenal tissue”. Data was collected for demographic characteristics, size and appearance of ectopic adrenal cortical rest and histopathology. Quantitative data has been presented as medians. Categorical variables have been presented as percentages.
Result
We encountered 43 cases of impalpable undescended testis, out of which, nubbins were identified in 9 cases. Incidence of EACT in nubbin and impalpable UDT was 2/9 (22.22%) and 2/43(4.7%) respectively. None of the excised nubbin had germ cells. On Systematic review, EACT associated with UDT was seen in 90/2501 (3.6%), while its association with testicular nubbin has been reported only once before in a case report.
Conclusion
A testicular nubbin is a condition wherein no viable testicular tissue can be grossly identified in a case of impalpable testis. Even when germ cells are not found in the excised nubbin, the presence of ectopic adrenal cortical rest make them prone to later malignant transformation. Association of EACT with UDT has been consistently reported but there is scarcity of such documentation in association with testicular nubbin.
The discovery of ectopic adrenal tissue in the hernial sac is very rare, and in the majority of reported cases it is in children, while it is never described in adult subjects. This could be due to a progressive previous atrophy of the ectopic tissue or to an insufficient examination of the sac removed surgically. The most frequent site of these ectopias is the kidney, adjacent to the adrenal glands. The presence of ectopic adrenal tissue is important because of its neoplastic and hyperplastic potential. We report a case of a 69-year-old male patient who underwent a surgical operation of a left inguinal hernia and that the presence of ectopic adrenal tissue was reported in the pathologist's report. Preoperative abdominal ultrasound should therefore be performed in patients destined for an inguinal hernia surgery, because also the rare existence of ectopic adrenal tissue in the hernial sac should be kept in mind. KEY WORDS: Adrenal, Adult, Ectopia, Herni sac.
