![]() TART is mainly described in poorly controlled patients but has also been reported in patients with suppressed ACTH and 17-hydroxyprogesterone concentrations. However, the pathology report confirmed a non-neoplastic testicular tumour of adrenogenital syndrome, also known as TART.Ĭongenital adrenal hyperplasia is characterized by disturbed steroid synthesis, most commonly due to 21-hydroxylase deficiency, leading to high ACTH levels. The patient underwent right orchiectomy due to high suspicion for underlying malignancy. Right cervical lymph node biopsy returned negative for malignancy. 3), raising suspicion for a primary testicular tumour. A positron emission tomography scan (PET) showed diffuse uptake in the testicles bilaterally, and hypermetabolic activity in a cervical lymph node and a right inguinal lymph node ( Fig. CT of the abdomen showed similar testicular findings and persistent adrenal glands enlargement. This was most consistent with an infiltrative process with the differential diagnosis including an infiltrative process related to the patient’s underlying endocrine abnormalities, amyloid deposition, diffuse enlargement secondary to neoplasm or infectious aetiologies such as orchitis. ![]() Testicular ultrasound with heterogeneous enlargement of the testicles bilaterally was noted without identifiable focal lesions as shown in Fig. Laboratory results showed normal beta-human chorionic gonadotropin, alpha fetoprotein (AFP) and lactate dehydrogenase (LDH) levels. Examination revealed diffuse skin hyperpigmentation, and bilateral firm testicular enlargement, with the right greater than the left. ![]() The patient returned to hospital with testicular pain. Oral steroid replacement was initiated and a follow-up arrangement was made with an endocrinologist, but the patient was lost to follow-up for about a year. Considering the size of the adrenal mass, a biopsy was recommended but the patient refused at that time. The 17-hydroxyprogesterone (17-OHP) level was 971 ng/dl, likely because the patient was on intermittent steroid replacement, while 21-hydroxylase antibody was normal. A 24-hour urine metanephrine test was negative. A sharp, sour or acidy taste that is provided by fruits such as lemons or cream products such as sour cream.Laboratory tests showed adrenocortical hormone (ACTH) 1490 pg/ml and cortisol <1 μg/dl, while a cosyntropin stimulation test was positive. While the Tartlet is most often served as an appetizer or a small serving for dessert, the Tart is often served as a larger piece of dessert or as a slice for a main meal.Ģ. Or, the Tart may be filled prior to baking so the filling and the shell bake at the same time. When prepared, the Tart may be blind baked, in order to first prepare the shell and then fill it with cold ingredients to be served as a cold food. When the Tart is made as a large pie-like food it then is prepared so numerous individual servings can be sliced from the whole Tart. The Tartlet may be a single, bite-sized version of a larger Tart such as an appetizer, or it may be a pastry larger than a bite size piece that is made as an individual dessert serving. A Tartlet, which may at times be used in reference to a Tart, is a term that applies to a smaller-sized Tart. Similar in meaning, a pie, a flan, a quiche, a tartlet, a tarte, or a tartelette all have an appearance and structure that is basically the same as a Tart. Each Tart is made to be filled and kept open without a top crust. It is made to be served as an open crust containing sweet fillings such as fruits, custards, or creams, as well as savory fillings that are most often served warm. Typically a Tart is made with a pastry dough that is light and flaky or a shortcrust that is dense and crumbly. A small, baked pastry that is round in shape with a shallow wall around the entire base.
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