case_images: PMC9373900_01
case_images: Clinical images of the patient (A) Enhanced CT scan showing a 40-mm round tumor with a relatively reduced contrast effect in the right renal hilum. (B) Remarkable 131I-labelled adosterol accumulation in the tumor but not in the adrenal glands. (C) CT scan showing dissymmetric bone thickening with a "ground-glass" appearance, which consisted of cystic or solid mass at right-frontoparietal region of the temporal bone. (D)
  99mTc-methylene diphosphonate (MDP) accumulation in the skull lesion.
case_images: fendo-13-934748-g001.jpg
case_images: PMC9373900_01_fendo-13-934748-g001.jpg
case_images: f1
case_images: Coincidentally, an enhanced CT scan showed a 40-mm round tumor on the right renal hilum (Figure 1A); the tumor remarkably accumulated 131I-labelled adosterol but not in the adrenal glands (Figure 1B). In addition, a head CT scan showed dissymmetric bone thickening with a "ground-glass" appearance, which consisted of a cystic or solid mass at right-frontoparietal region of the temporal bone (Figure 1C). Bone scintigraphy showed that 99mTc-methylene diphosphonate (MDP) accumulated in multiple bones, including skull lesions (Figure 1D), suggesting that these bone features were caused by fibrous dysplasia.
case_images: Immunohistochemical staining of the tumor on the right renal hilum Immunohistochemical staining confirmed a pituitary adenoma that was markedly positive for (A) StAR, (B) CYP11A1, (C) CYP17A, (D) HSD3B, (E) CYP21A, (F) CYP11B1, and (H) SF-1. (G and I) Staining for CYP11B2 and Ki-67 was negative.
case_images: fendo-13-934748-g002.jpg
case_images: PMC9373900_01_fendo-13-934748-g002.jpg
case_images: f2
case_images: Positive immunohistochemical staining for StAR, CYP11A1, CYP17A, HSD3B, CYP21A, CYP11B1, and SF-1 (Figures 2A-F, H) indicated that the tumor was capable of producing cortisol from cholesterol, a source reagent, via an authentic enzymatic reaction. In contrast, staining for CYP11B2 and Ki-67 was negative (Figures 2G, I).