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case_images: (A) In pre-operative photos seems overweight with excessive hair growth all over her body (hirsutism) and pustular acne on her face. (B) 6-month post-op photos show a dramatically reduced body weight, appearing similar to her age group, and a total absence of body hair.
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case_images: She had cushingoid facies, signs of virilization in the form of pustular acne, hirsutism (axillary and facial hair in Figure 1A), and clitoromegaly. And all the symptoms disappeared 6 months after the operation (Figure 1B).
case_images: Abdominal ultrasound shows well-defined adrenal mass appearing slightly heterogeneous mixed hyper and hypoechoic consistent with smooth margins (white arrow).
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case_images: As usual in pediatric cases, in the beginning, an abdominal ultrasound (US) was performed, showing a well-defined adrenal mass with a slightly heterogeneous mix of hyper- and hypoechoic consistency with smooth margins (Figure 2).
case_images: Axial and coronal contrast-enhanced abdominal computed tomography showed that 6 cm right adrenal fossa well-defined heterogeneously enhanced mass lesion containing hypodense necrotic areas and slightly displaces right kidney inferiorly (blue arrow).
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case_images: For further investigation and lesion characterization, computed tomography (CT) of the abdomen has done, revealing that the right adrenal fossa well-defined a 6 cm sized mass lesion with heterogeneous contrast enhancement containing hypodense necrotic areas and slightly displaces right kidney inferiorly (Figure 3).
case_images: Histopathological examination shows (A) encapsulated tumor composed of variably sized nests, large sheets, and trabeculae, areas of necrosis, hemorrhage, and degeneration areas. (B) Low grade: <=20 mitoses/50 high power fields morphologic subtypes, Oncocytic (>75% oncocytic cells). (C) Large cells with granular clear to eosinophilic cytoplasm, pleomorphic Intranuclear inclusions, mitoses, and atypical mitoses. (D) Gross surgical specimen of a removed adrenal mass.
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case_images: Next, the solid mass was excised by means of unilateral right adrenalectomy (Figure 4). According to these findings, the case was diagnosed with oncocytic ACC (Figure 4).