{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T20:25:42Z","timestamp":1779395142798,"version":"3.53.1"},"reference-count":26,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,8,29]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p>Oncocytic adrenocortical neoplasms are a rare histopathological subtype of adrenal tumours which are usually benign and, if malignant, are less likely to metastasise. We report a case of a non-functioning oncocytic adrenocortical tumour, identified incidentally in a middle-aged woman. It was initially reported as a left-sided 3.5\u00d73.4\u00d75.6\u2009cm adrenal adenoma. It however increased in size to 5.4\u00d74.0\u00d74.3\u2009cm on follow-up scans. Subsequent review of the scans revealed an indeterminate lesion with a precontrast density of 30 Hounsfield units, an absolute washout of 42.6% and a relative washout of 28.6%. As a result, laparoscopic left adrenalectomy was performed. Histology confirmed oncocytic adrenocortical carcinoma when using the Lin-Weiss-Bisceglia system, though it was deemed benign when using the Helsinki scoring system. There has been no evidence of recurrence to date. This case highlights the potential pitfalls in the diagnosis of oncocytic neoplasms and the increased specificity of the Helsinki score in assessing metastatic potential.<\/jats:p>","DOI":"10.1136\/bcr-2022-250900","type":"journal-article","created":{"date-parts":[[2022,9,15]],"date-time":"2022-09-15T10:56:26Z","timestamp":1663239386000},"page":"e250900","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Oncocytic adrenocortical tumour presenting as an incidentaloma: a diagnostic challenge"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0947-8153","authenticated-orcid":false,"given":"Carol D","family":"Cardona Attard","sequence":"first","affiliation":[{"name":"Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Gauci","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel","family":"Gatt","sequence":"additional","affiliation":[{"name":"Pathology Department, Mater Dei Hospital, Msida, Malta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren","family":"Scicluna","sequence":"additional","affiliation":[{"name":"Medical Imaging Department, Mater Dei Hospital, Msida, Malta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario J","family":"Cachia","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,9,15]]},"reference":[{"key":"2025082709163279000_15.9.e250900.1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e31822da401"},{"key":"2025082709163279000_15.9.e250900.2","doi-asserted-by":"crossref","first-page":"225","DOI":"10.4274\/jcrpe.galenos.2020.2020.0060","article-title":"Two subsequent Metachroneus solid tumors: oncocytic variant adrenocortical carcinoma and rhabdomyosarcoma of childhood: case report and literature review","volume":"13","author":"Ak\u0131n","year":"2021","journal-title":"J Clin Res Pediatr Endocrinol"},{"key":"2025082709163279000_15.9.e250900.3","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.3880638"},{"key":"2025082709163279000_15.9.e250900.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2010.08.010"},{"key":"2025082709163279000_15.9.e250900.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0720-048X(01)00444-2"},{"key":"2025082709163279000_15.9.e250900.6","doi-asserted-by":"publisher","DOI":"10.1677\/ERC-07-0045"},{"key":"2025082709163279000_15.9.e250900.7","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-16-0467"},{"key":"2025082709163279000_15.9.e250900.8","doi-asserted-by":"publisher","DOI":"10.1159\/000345141"},{"key":"2025082709163279000_15.9.e250900.9","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.rcl.2016.10.005","article-title":"Practical approach to adrenal imaging","volume":"55","author":"Elsayes","year":"2017","journal-title":"Radiol Clin North Am"},{"key":"2025082709163279000_15.9.e250900.10","doi-asserted-by":"crossref","first-page":"2756","DOI":"10.1245\/s10434-020-09329-1","article-title":"A critical analysis of computed tomography washout in lipid-poor adrenal incidentalomas","volume":"28","author":"Akbulut","year":"2021","journal-title":"Ann Surg Oncol"},{"key":"2025082709163279000_15.9.e250900.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.tem.2004.06.012"},{"key":"2025082709163279000_15.9.e250900.12","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/j.surg.2019.05.049","article-title":"Oncocytic subtypes of adrenal cortical carcinoma: aggressive in appearance yet more indolent in behavior?","volume":"166","author":"Mills","year":"2019","journal-title":"Surgery"},{"key":"2025082709163279000_15.9.e250900.13","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1016\/j.surg.2018.04.044","article-title":"Adrenocortical oncocytic neoplasm: a systematic review","volume":"164","author":"Kanitra","year":"2018","journal-title":"Surgery"},{"key":"2025082709163279000_15.9.e250900.14","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1038\/s41379-018-0077-8","article-title":"Clinicopathological description of 43 oncocytic adrenocortical tumors: importance of Ki-67 in histoprognostic evaluation","volume":"31","author":"Renaudin","year":"2018","journal-title":"Mod Pathol"},{"key":"2025082709163279000_15.9.e250900.15","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.anndiagpath.2009.06.006","article-title":"Oncocytic adrenocortical carcinoma","volume":"14","author":"Ohtake","year":"2010","journal-title":"Ann Diagn Pathol"},{"key":"2025082709163279000_15.9.e250900.16","first-page":"E45","article-title":"Images - 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