PMC6051277_01
MRI abdomen with and without contrast. A 3.4 x 4.0 x 4.7 cm mass is seen in the left adrenal gland. The lesion demonstrated heterogeneous T2 hyperintense/T1 isointense to muscle signal. The T1 signal of the lesion was hypointense relative to the contralateral right adrenal gland.
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fig1
This revealed a 3.4 x 4.0 x 4.7 cm mass in the left adrenal gland which demonstrated heterogenous T2 hyperintense/T1 isointense muscle signal [Figure 1].
Pathology from left adrenal. H&E (100x). Classic pattern of small nests (zellballen) made up of polygonal neuroendocrine cells (chief cells). The nests are separated by interspersed small blood vessels and sustentacular cells.
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fig2
This was consistent with a pheochromocytoma [Figures 2-5].
Pathology from left adrenal. H&E (400x). High power depicts ample and finely granular eosinophilic cytoplasm. The nuclei exhibit typical "salt and pepper" chromatin, characteristic of all neuroendocrine tumors. Nuclei are round to oval and uniform without significant pleomorphism or mitotic activity. Nucleoli are inconspicuous.
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fig3
This was consistent with a pheochromocytoma [Figures 2-5].
Pathology from left adrenal. Chromogranin (100x). Cytoplasmic granular staining diffusely positive in tumor cells.
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fig4
This was consistent with a pheochromocytoma [Figures 2-5].
Pathology from left adrenal. Synaptophysin (100x). Cytoplasmic granular staining diffusely positive in tumor cells.
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fig5
This was consistent with a pheochromocytoma [Figures 2-5].