PMC3804829_01
Computed tomography (CT) revealing a solid, well-defined edge and a homogeneous mass in the left adrenal gland. A) Unenhanced CT scan showing left adrenal mass (22 HU); B) enhanced CT scan showing left adrenal mass (111 HU); C) delayed enhanced CT scan showing left adrenal mass (29 HU). Enhancement washout = 82 HU (111-29 HU); enhancement = 89 HU (111-22 HU); percentage enhancement washout = 92% [(enhancement washout/enhancement) = (82/89) x 100].
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Attenuation measurements were 22 Hounsfield units (HU) on the precontrast image, 111 HU on the arterial phase image, and 29 HU on the delayed phase image (Figure 1). Mitotic figures were rare (<1/20 under high-power field).
Magnetic resonance images showing an adrenocortical neoplasm exhibiting no loss of signal intensity on out-of-phase imagery. The neoplasm showed high signal intensity on T2-weighted and DWI images. A) Axial in-phase; B) out-of-phase; C) T2-weighted; D) DWI.
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Magnetic resonance imaging (MRI) showed no loss of signal intensity in T1-weighted out-of-phase images but high signal intensity on T2-weighted and diffusionweighted images (DWI) (Figure 2).
A) Myxoid adrenocortical tumor, well circumscribed and of golden yellow gelatinous appearance; B) extracellular acidic mucosubstances in the acellular myxoid areas (Alcian blue stain, OLYMPUS BX60, magnification x100); C) infiltration into adipose tissue (hematoxylin-eosin (HE) stain, OLYMPUS BX60, magnification x100); D) some cells demonstrating high nuclear grade (HE stain, OLYMPUS BX60, magnification x200); E) intact frame network (reticulin stain, OLYMPUS BX60, magnification x100)
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The mass was macroscopically visualized as a well-circumscribed, golden yellow tumor (Figure 3A), histologically characterized by an incomplete capsule and focally infiltrative margin. Tumor cells contained scant cytoplasm, although clear cells with relatively abundant cytoplasm were focally observed (Figure 3B, C). Hematoxylin and Eosin staining revealed that tumor cells were present outside the capsule and had infiltrated the fatty tissue without disruption of the reticulin network (Figure 3C, 3E). The tumor fulfilled 2 of the Weiss criteria (paucity of clear cells, high nuclear grade only focally) (Figure 3D).