Is Adrenal Ovarian Thecal Metaplasia a Misnomer? Report of Three Cases of Radial Scar-Like Spindle Cell Myofibroblastic Nodule of the Adrenal Gland

Ovarian thecal metaplasia is a rare tumor-like mesenchymal lesion of the adrenal gland that has been reported mainly in postmenopausal women and rarely in men. It was originally described as a wedge-shaped lesion composed of ovarian-like stroma resembling theca that shows continuity with the capsule of the adrenal gland. We report three cases and identify that these lesions can resemble a radial scar. While a single case has been reported to contain true ovarian stromal elements, there was no evidence of steroidogenic differentiation in our cases. These findings justify the need for a better terminology since the entity falls within the spectrum of fibroblastic–myofibroblastic proliferations. We propose the terminology of “radial scar-like spindle cell myofibroblastic nodule of the adrenal gland” as a more accurate nomenclature to designate these lesions. Although rare, calcifying fibrous tumor of the adrenal gland, hypertrophic nerve bundles, and peripheral nerve sheath tumors may mimic these lesions.