Adrenocortical carcinoma (ACC) is a rare malignancy and cytodiagnosis of this tumor is not routinely encountered by a cytopathologist.Here, we report a case of ACC initially diagnosed by computed tomography (CT)-guided fine needle aspiration cytology (FNAC) with the help of immunocytochemistry.A 48-year-old lady presented with flank pain and abdominal mass for the last 6 months.
A CT scan of her abdomen revealed a large mass arising from the upper part of the left NEW Neff V6320X1GB 7kg Wash 4kg Dry 1400rpm Integrated Washer Dryer -White kidney.CT-guided FNAC was performed.Cytologic smears showed pleomorphic large cells arranged discretely and in Tops small aggregates against a myxoid background.
The cells had a high nucleocytoplasmic ratio, anisonucleosis and conspicuous nucleoli.Based on cytomorphology, differential diagnoses of ACC and renal cell carcinoma (RCC) were made.On immunocytochemistry, the tumor cells were synaptophysin, inhibin, vimentin and Melan-A positive but cytokeratin and epithelial membrane antigen negative.
Thus, a cytodiagnosis of myxoid ACC was made and histopathologic examination was suggested.Subsequent histologic examination and immunohistochemistry proved the case to be myxoid ACC.