PMC4313515_01
In phase axial image: 11 x 12 x 13 cm well defined hypointense lesion anterior and superior to Lt. kidney abutting the renal vessels and Lt. crus of diaphragm with no signal voids indicating calcification and no hyper intense signal indicating fat content or hemorrhage.
CRIS2015-702541.001.jpg
PMC4313515_01_CRIS2015-702541.001.jpg
fig1
T2 weighted TSE SPIR postcontrast sequence showed an 11 x 12 x 13 cm oval mass with heterogeneous enhancement with nonenhancing area due to cystic degeneration in the anteromedial aspect of the left kidney displacing it posteroinferiorly. The tumor was seen abutting the splenic vein and abdominal aorta and stretching the left renal vein and artery leading to the diagnosis of adrenal tumor rather than renal origin (Figures 1 and 2). The right kidney, liver, right adrenal gland, and the gall bladder were within normal limits with no enlarged abdominal lymph nodes.
Sagittal T2W image: the lesion shows intermediate signal with multiple small hyper intense areas due to necrosis.
CRIS2015-702541.002.jpg
PMC4313515_01_CRIS2015-702541.002.jpg
fig2
T2 weighted TSE SPIR postcontrast sequence showed an 11 x 12 x 13 cm oval mass with heterogeneous enhancement with nonenhancing area due to cystic degeneration in the anteromedial aspect of the left kidney displacing it posteroinferiorly. The tumor was seen abutting the splenic vein and abdominal aorta and stretching the left renal vein and artery leading to the diagnosis of adrenal tumor rather than renal origin (Figures 1 and 2). The right kidney, liver, right adrenal gland, and the gall bladder were within normal limits with no enlarged abdominal lymph nodes.
Spindly tumor cells with eosinophilic cytoplasm, blunt ended nuclei with bizarre nucleus. H&E x40.
CRIS2015-702541.003.jpg
PMC4313515_01_CRIS2015-702541.003.jpg
fig3
Microscopic examination revealed a high grade spindle cell malignant tumor composed of diffuse proliferation of large pleomorphic spindly cells with eosinophilic cytoplasm and spindly, blunt ended vesicular nuclei (Figure 3).
The tumor cells are strongly positive for desmin immunohistochemistry. Desmin 40x.
CRIS2015-702541.004.jpg
PMC4313515_01_CRIS2015-702541.004.jpg
fig4
Immunohistochemistry was performed which revealed that the tumor cells were strongly positive for desmin (Figure 4) and vimentin and negative for calretinin, inhibin, chromogranin, synaptophysin, S100, pan keratin, and CD68.