PMC8267922_01
(A) In chest X-ray, permeability was reduced in bilateral lower lung field and butterfly shadow was observed. Cardio-thoracic ratio (CTR) was 59.8% and both costophrenic angles (CPA) were blunt. (B) Abdominal contrast-enhanced computed tomography revealed a 50-mm hyper-vascularized tumor with calcification in the right adrenal gland and multiple hyper-vascularized tumors in the liver. The right adrenal gland showed round shape and a mixture of high- and low-density area. In addition, since there was thin adipose tissue between the right adrenal gland and the kidney and inferior vena cava, there seemed to be no infiltration into surrounding organs. (C) In 131I MIBG scintigraphy, there was high accumulation in the right adrenal gland and multiple accumulation in the liver, and there was small hot spot in the sternum and right rib.
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Cardio-thoracic ratio (CTR) was 59.8% and both costophrenic angles (CPA) were blunt ( Figure 1A ). Abdominal contrast-enhanced computed tomography revealed a 50-mm hyper-vascularized tumor with calcification in the right adrenal gland and multiple hyper-vascularized tumors in the liver ( Figure 1B ). In 131I MIBG scintigraphy, there was high accumulation in the right adrenal gland and multiple accumulation in the liver, and there was small hot spot in the sternum and right rib ( Figure 1C ).
(A) Time course of noradrenaline, vascular endothelial growth factor (VEGF), and brain natriuretic peptide (BNP). Noradrenaline and VEGF levels were drastically decreased after right adrenal tumor resection, and BNP level was also gradually decreased before the operation. (B) In HE staining of the resected left hepatic lobe, there was small solid alveolar structure with a lot of relatively small cells and spindle-shaped nuclei were observed in some of such cells (left panel). In addition, in chromogranin A staining, many chromogranin A-producing cells were observed (right panel).
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As shown in  Figure 2A , noradrenaline level was markedly decreased after the operation. In hematoxylin and eosin (HE) staining of the resected left hepatic lobe, there was small solid alveolar structure with a lot of relatively small cells and spindle-shaped nuclei were observed in some of such cells ( Figure 2B ).