Malignant transformation of a mature teratoma of the adrenal gland: A rare case report and literature review

RATIONALE: Adrenal mature TMT is very rare. So far, only two cases have been reported. PATIENT: We report a rare case of malignant transformation of a mature teratoma in the right adrenal gland of a 36-year-old Chinese female. The patient had been asymptomatic until physical exam identified a palpable mass in the right abdomen. Abdominal non-enhanced computed tomography (CT) scan showed a huge tumor with mixed density in right adrenal region, which had cystic components, fat, calcifications, and separations. Contrast-enhanced CT showed significant enhancement of the cyst wall and septations as well as mural nodules. In addition, the patient had four abnormal laboratory results, including cortisol 773.58 mol/L ↑ (reference range 118.6 to 618 mol/L), adrenocorticotropic hormone (ACTH) 70.980 pg/ml ↑ (reference range 7.2 to 63.3 pg/ml), aldosterone 317.84 pg/ml ↑ (reference range prone: 49.3–175 pg/ml; Standing: 34.7–275 pg/ml; 24h urine 2.84–33.99 ug/d), and vanillyl mandelic acid (VMA) 22.38 mg / 24 h ↑ (reference range 0–13.6 mg / 24 h) which to our knowledge have not been reported by any adrenal mature teratoma's reference literature. DIGNOSES: It was initially diagnosed as a right adrenal hamartoma by the radiologist. Final pathology confirmed it as malignant transformation of a right adrenal mature teratoma, which is extremely rare. INTERVENTIONS: Laparoscopic resection is usually the treatment of choice for adrenal teratoma and our case report is no exception. OUTCOMES: This article is a case report, no outcomes. LESSONS: Non-enhanced CT findings of a mass with cystic change, fat, calcification and separation are suggestive of a teratoma. If there is significant enhancement of the cyst wall and septations as well as mural nodules in contrast-enhanced CT, then adrenal TMT should be considered. In addition, abnormal levels of hormones including cortisol, ACTH, aldosterone and VMA may also aid in the diagnosis of adrenal TMT.