Open AccessA case of estrogen‐secreting adrenocortical carcinoma: Comprehensive immunohistochemical analysis of disorganized steroid genesis
Author(s) -
Yokoyama Megumi,
Kijima Toshiki,
TakadaOwada Atsuko,
Sakamoto Kazumasa,
Suzuki Issei,
Nishihara Daisaku,
Nakamura Yasuhiro,
Ishida Kazuyuki,
Kamai Takao
Publication year - 2021
Publication title -
iju case reports
Language(s) - English
Resource type - Journals
ISSN - 2577-171X
DOI - 10.1002/iju5.12336
Subject(s) - adrenocortical carcinoma , estrogen , aromatase , immunohistochemistry , estrone , medicine , endocrinology , carcinoma , testosterone (patch) , cancer , breast cancer
Adrenocortical carcinoma rarely secretes estrogens, and little is known regarding the mechanism of intra‐tumor estrogen production. We report an estrogen‐secreting adrenocortical carcinoma in a postmenopausal woman, where comprehensive immunohistochemical analyses of the resected tumor revealed disorganized steroidogenesis. Case presentation A 68‐year‐old woman presented with postmenopausal vaginal bleeding and was found to have a left adrenal tumor. Serum estradiol and testosterone were elevated but they normalized after resection of the tumor, suggestive of adrenocortical carcinoma with disorganized steroidogenesis. Immunohistochemical analyses revealed that the tumor expressed aromatase which converts androgens into estrogens. Furthermore, the tumor lacked 17βHSD2, which converts estradiol to estrone, suggesting that estradiol accumulated as the final product of the tumor's steroidogenic pathway. Conclusion The capability of adrenocortical carcinoma to produce estrogen can be demonstrated by comprehensive immunohistochemical analyses of steroidogenic enzymes, such as those reported here.