Cushing syndrome as presenting symptom of calcifying nested stromal-epithelial tumor of the liver in an adolescent boy: a case report

J Med Case Rep. 2016 Jun 16:10:160. doi: 10.1186/s13256-016-0951-2.

Abstract

Background: Ectopic adrenocorticotropic hormone-producing primary liver tumors are rare, especially in children. We report the case of an adolescent boy of mixed Dutch and Moroccan descent with an adrenocorticotropic hormone-producing calcifying nested stromal-epithelial tumor with long-term follow-up. Thus far, only two such cases have been reported.

Case presentation: A 16-year-old boy of mixed Dutch and Moroccan descent presented with Cushing syndrome and a palpable abdominal mass. A calcifying nested stromal-epithelial tumor was diagnosed. Postoperatively, his plasma adrenocorticotropic hormone concentration normalized. He remains in complete remission 13 years after tumor resection.

Conclusions: Calcifying nested stromal-epithelial tumor should be in the differential diagnosis of liver tumors, especially if associated with Cushing syndrome as significant morbidity and mortality may be associated. Literature on the topics involved is comprehensively reviewed.

Keywords: Calcifying nested stromal–epithelial tumor of the liver; Desmoplastic nested spindle cell tumor of liver; Ectopic ACTH production; Liver tumor; Pediatric.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adrenocorticotropic Hormone / blood
  • Calcinosis / complications
  • Calcinosis / diagnosis
  • Cushing Syndrome / blood
  • Cushing Syndrome / diagnosis
  • Cushing Syndrome / etiology*
  • Diagnosis, Differential
  • Epithelium / pathology
  • Humans
  • Liver / pathology
  • Liver Neoplasms / blood
  • Liver Neoplasms / complications*
  • Liver Neoplasms / diagnosis
  • Male
  • Morocco
  • Netherlands
  • Stromal Cells / pathology

Substances

  • Adrenocorticotropic Hormone