PMC5838465_01
Hyperplastic adrenal cortex.
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fig1
Diffuse adrenal cortical hyperplasia was noted (Figure 1).
Adrenal gland, pheochromocytoma, and diffuse growth pattern with high cellularity. H&E x40.
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fig2
Immunostaining was positive for ACTH and synaptophysin and negative for chromogranin, inhibin, calretinin, and S-100 protein.  Figure 2 shows the pathology of adrenal tumor, pheochromocytoma, and diffuse growth pattern.  Figure 3 depicts positive immunostraining for ACTH.  Figure 4 depicts the tumor's vascular invasion, and the adrenal gland's hyperplastic cortex.
Positive Immunostaining for ACTH compatible with ectopic ACTH secretion by the tumor.
CRIE2018-3963274.003.jpg
PMC5838465_01_CRIE2018-3963274.003.jpg
fig3
Immunostaining was positive for ACTH and synaptophysin and negative for chromogranin, inhibin, calretinin, and S-100 protein.  Figure 2 shows the pathology of adrenal tumor, pheochromocytoma, and diffuse growth pattern.  Figure 3 depicts positive immunostraining for ACTH.  Figure 4 depicts the tumor's vascular invasion, and the adrenal gland's hyperplastic cortex.
Tumor, vascular invasion at tumor edge, and hyperplastic cortex. The arrow represents vascular invasion of the tumor.
CRIE2018-3963274.004.jpg
PMC5838465_01_CRIE2018-3963274.004.jpg
fig4
Immunostaining was positive for ACTH and synaptophysin and negative for chromogranin, inhibin, calretinin, and S-100 protein.  Figure 2 shows the pathology of adrenal tumor, pheochromocytoma, and diffuse growth pattern.  Figure 3 depicts positive immunostraining for ACTH.  Figure 4 depicts the tumor's vascular invasion, and the adrenal gland's hyperplastic cortex.