PMC9207559_01
Ultrasound images of the right adrenal mass. (A) Initial ultrasound scan showing enlargement of the right adrenal gland (*). (B) A subsequent ultrasound scan approximately 11 months later showed progressive enlargement (calipers) of the right adrenal gland (*) and (C) in close association with the caudal vena cava (CVC, blue) but no evidence of invasion.
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F1
At initial diagnosis, the right adrenal gland was measured as 1.26 cm in comparison to the left adrenal gland, which measured 0.5 cm (Figure 1). The mass was encroaching on the right phrenicoabdominal vein but invasion into the vein could not be determined using ultrasound, and computed tomographic evaluation was recommended (Figure 1).
Computed tomography (CT) image of phase 2 post-contrast study of the abdomen showing the mass associated with the caudal pole of the right adrenal gland with rim enhancement and mild homogenous central enhancement (white arrow).
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F2
The right phrenicoabdominal vein was in close apposition to the caudal aspect of the adrenal nodule and the right adrenal gland was in close apposition to the caudal vena cava without visible flattening or filling defects (Figure 2).
Intra-operative image showing mass associated with the right adrenal gland (arrow). Cranial is at the top of the image and caudal is at the bottom of the image.
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F3
Malleable retractors were utilized to improve visualization and the overlying fat was carefully dissected following incision into the peritoneum overlying the right kidney until the adrenal gland and associated mass were visible (Figure 3).
(A) Histology of adrenal cyst wall showing lining of uniform columnar epithelial cells (black arrow) overlying a thin fibrous capsule. Normal adrenal cortical parenchyma is at the top of the image. H&E stain. 200x magnification. (B) Histology of adrenal cyst wall stained with Chromogranin A showing negative staining of the cyst lining (black arrow) and non-specific staining of the proteinaceous cyst content. Internal positive control of adrenal medullary cells (*) and internal negative control of adrenal cortical cells (black triangle) is included. 200x magnification.
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F4
Histopathology showed an expansile, encapsulated cyst lined by a single layer of plump to attenuated to cuboidal to columnar epithelial cells (Figure 4). There was generalized indistinct staining of the proteinaceous cyst content, considered to be a non-specific reaction (Figure 4).