The Intricate Puzzle of Adrenocortical Tumors: Revisitation of Two Old Cases of Virilizing Adrenocortical Neoplasia with Contradictory Diagnostic and Histopathological Findings and Opposite Conclusions

Two old cases of adrenocortical tumors with contradictory diagnostic findings and opposite conclusions are revisited in light of the recent WHO guidelines, as follows: a 34-year-old woman and a 15-month-old girl, both with severe virilization and adrenal mass at radiological investigation, studied in 1966 and 1977, respectively, in accordance with the diagnostic procedures available in those years. Dynamic hormonal findings seemed to exclude malignancy in the woman but were in favor of malignancy in the girl. Instead, a 305 gr mass on the right adrenal gland was removed in the woman and histopathologically verified as adrenocortical carcinoma, whereas in the girl, a 140 gr mass in the right adrenal gland was removed and histopathologically verified as adrenocortical adenoma. After a six-month span of clinical condition improvement, the woman developed recurrence with multi-organ metastases. Mitotane treatment temporarily improved her condition, but it progressively worsened until her death 11 months later. The girl instead showed progressive improvement in clinical and laboratory findings until complete normalization in 18 months. The use of dated radiological and laboratory investigations suggests caution against generalization of our assumption; however, these cases suggest that only histopathological findings from surgical specimens ensure a correct diagnosis of adrenocortical masses.