Publication: Adrenal cyst with both Müllerian and mesothelial differentiation - a clinicopathological and immunohistochemical study with implications for histogenesis
Authors
Kopersk, Łukasz i ; Szczepankiewicz, Benedykt ; Pihowicz, Paweł ; Fus, Łukasz ; Wolińska, Ewa ; Górnicka, Barbara
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Publisher
Universidad de Murcia. Departamento de Biología Celular e Histología
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DOI
DOI: 10.14670/HH-11-870
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info:eu-repo/semantics/article
Description
Abstract
True epithelial-lined cysts are rare forms of
adrenal cystic lesions, the pathogenesis of which is still
not fully understood. In this report we present a case of
an adrenal cyst diagnosed incidentally on imaging in a
31-year-old, previously healthy, obese woman. Due to
non-specific hormonal disorders and enlargement of the
lesion, a right-sided laparoscopic adrenalectomy was
performed. The cyst was lined predominantly by ciliated
cuboidal-to-columnar, Müllerian-type epithelium, and
focally by flat-to-cuboidal, mesothelium-like lining.
Immunohistochemistry demonstrated a strong positive
reaction in the cells of both types of lining for
CKAE1/AE3, CK19, CK7 and WT1, and both had a
negative reaction for CK20, CD34, Melan-A, SF1,
TTF1, SMA and CDX2. The cells of the ciliated
cuboidal-to-columnar epithelium were strongly positive
for PAX8, ER, Ep-CAM and EMA, focally positive for
PR, and were negative for calretinin, whereas the cells of
the flat-to-cuboidal lining were positive for calretinin
and podoplanin and showed only a weak positive
response in individual cells for PAX8, EMA and EpCAM, but were negative for ER and PR. This is the first
reported case of an adrenal ciliated epithelial cyst with
Müllerian differentiation (confirmed immunohistochemically) in the English literature. The differences in
morphology and immunophenotype of the two types of
lining (epithelial Müllerian phenotype versus
mesothelial phenotype), suggest that some adrenal
epithelial cysts probably form due to metaplasia of
mesothelium-derived lining. A similar mechanism may
also be involved in the pathogenesis of at least some of
the so-called Müllerian cysts (or inclusions) in other
locations
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