Presentation
Flank pain.
Patient Data
Left adrenal tumor measures 6.5 cm. Central hypodensity and calcification with vivid peripheral enhancement.
Normal right adrenal gland. No lymphadenopathy. Remainder of the study unremarkable.
Case Discussion
Patient underwent a Gatate PET-CT (not shown) and the mass demontrated uptake, consistent with a neuroendocrine tumor. The patient proceeded to adrenalectomy.
Histopathology report
MACROSCOPIC DESCRIPTION: "Left adrenal gland tissue": The specimen consists of multiple fragments of adipose tissue and adrenal gland weighing 95 g and measuring 150 x 85 x 34 mm in aggregate. In some fragments, an encapsulated cream tumor is identified. Elsewhere, there are fragments of yellow normal appearing adrenal gland. Macroscopically, no definite capsule breach is present, however, this is difficult to assess due to the fragmented nature of the specimen.
MICROSCOPIC DESCRIPTION: Sections show an encapsulated tumor and adjacent fibroadipose tissue. Tumor consists of nests of cells of varying size, divided by numerous slit-like vascular spaces and fibrous tissue. Cells are spindle to epithelioid and have moderately large, moderately pleomorphic round to oval nuclei with vesicular chromatin and vacuolated amphophilic cytoplasm. There is extensive tumor necrosis with some calcification. There is no definite lymphovascular or perineural invasion. Mitoses are not identified. Margins cannot be assessed.
By immunohistochemistry the tumor cells are positive for chromogranin, synaptophysen, CD56 and AE1/3 and negative for calretinin, inhibin and melanA. S100 shows scattered staining in rare single cells.
DIAGNOSIS: Left adrenal gland tissue: Pheochromocytoma.
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