PMC3039620_01
MRI scan of the upper abdomen disclosing bilateral adrenal tumors.
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F1
The preoperative imaging investigation of the patient included: magnetic resonance imaging (MRI) of the head disclosing a 1.4 x 1.3 cm pituitary adenoma, cervical ultrasound and Tc99 m Sestamibi-scans both disclosing hyperplasia of the parathyroid glands, abdominal MRI scan and endoscopic ultrasound (EUS) both disclosing a 4.5 x 3.0 cm tumor in the body and tail of the pancreas, fine needle aspiration biopsy (FNAB) of the pancreatic tumor under EUS guidance concluding in histological findings compatible to neuroendocrine tumor, somatostatin receptor imaging with Indium 111 (OctreoScan ) disclosing radionuclide material uptake in the left upper quadrant of the abdominal cavity at some point between the left lobe of the liver and the spleen, while in the abdominal MRI scan bilateral adrenal tumors (right adrenal 8.0 Chi 4.5 cm and left adrenal 7.5 x 5.5 cm) (Figure 1), as well as a fully calcified ectopic left kidney into the pelvis, were detected.
Histological section (H&E counterstain) of the adrenocortical neoplasm in the left adrenal gland, depicting cells with moderate to marked nuclear pleomorphism (magnification X200).
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F2
There was mild to moderate nuclear atypia and the mitotic figures were less than 2 per 10 HPF (magnification X40). The neoplastic population consisted of round to oval cells, with scant eosinophilic cytoplasm and moderate to marked nuclear pleomorphism, arranged in a loose growth pattern (Figure 2).