PMC4779821_01
CT scan showing 11.3 cm x 9.7 cm right adrenal mass with scattered calcifications.
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fig1
CT scan confirmed an 11.3 x 9.4 cm right adrenal mass with scattered calcifications consistent with adrenal CA (Figure 1). 24-hour urinary catecholamines, metanephrines, plasma cortisol, and aldosterone were normal.
PMC4779821_02
Thick-walled blood vessels and smooth muscle spindle cells interspersed among numerous adipocytes (magnification 200x, hematoxylin and eosin stain).
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fig2
The 626 g, 13 x 12 x 9 cm specimen contained adipose tissue, thick walled blood vessels, and scattered foci of spindle cells with areas of hemorrhage and calcifications on H&E stain (Figure 2).
PMC4779821_03
Complex right adrenal mass on MRI with no evidence of invasion.
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fig3
MRI clarified the lesion as adrenal with no invasion of surrounding structures (Figure 3).
Right adrenal PEComa. It was a 14.5 x 12 x 7 cm fleshy tumor with necrosis and hemorrhage.
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fig4
The mass was excised and sent to pathology (Figure 4).
PMC4779821_04
Focal alveolar pattern. These areas are suggestive of an alveolar soft part sarcoma.
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fig5
The tumor replaced the adrenal gland in its entirety but the capsule was intact, with various growth patterns (Figures 5 and 6).
PAS stains carbohydrate moieties such as glycogen. This was a granular material more consistent with a PEComa.
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fig6
The tumor replaced the adrenal gland in its entirety but the capsule was intact, with various growth patterns (Figures 5 and 6).