PMC5742014_01
Treatment history and serum PIVKA levels for 90months prior to the current presentation. Each intervention is marked by a serum PIVKA level before and after. Serum PIVKA levels are elevated for five of seven recurrences, and then return to normal after treatment. Serum PIVKA was not elevated before two of the radiofrequency ablation (RFA) procedures.
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CT scans have been obtained at three-month intervals and serum PIVKA levels checked monthly (Fig. 1).
PMC5742014_02
Treatment history and serum PIVKA levels for 90months prior to the current presentation. Each intervention is marked by a serum PIVKA level before and after. Serum PIVKA levels are elevated for five of seven recurrences, and then return to normal after treatment. Serum PIVKA was not elevated before two of the radiofrequency ablation (RFA) procedures.
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CT scans have been obtained at three-month intervals and serum PIVKA levels checked monthly (Fig. 1).
PMC5742014_03
Computed tomography scans of the abdomen show a 2.5 cm mass in the right adrenal gland (arrow). Left upper image: non-enhanced, left lower: early arterial phase, right upper: late arterial phase, right lower: late portal phase. The tumor is markedly enhanced in the early arterial phase but not in the portal phase.
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At 90months after resection of the primary tumor, routine CT scan showed a mass in the right adrenal gland (Fig. 2).
Magnetic resonance imaging shows an enhanced 3 cm mass in the right adrenal gland (arrow). Left upper image: T1-weighted image, left lower: T2-weighted image, right upper: dynamic sequence, right lower: Diffusion weighted image (DWI) sequence (b = 1000). The adrenal gland tumor is markedly enhanced in the early arterial phase (similar to the computed tomography images). The T2-weighted image shows a high intensity signal and diffusion restriction is noted in the DWI sequences.
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T2 weighted images (Fig. 3).
PMC5742014_04
Histology of the right adrenal mass. Left Upper: Macroscopic image shows a 3 cm tumor in the right adrenal gland. Right Upper: Microscopic findings (Hematoxylin and eosin stain, x100) shows the border of the adrenal gland tissue with a nest of neuroendocrine cells. Left Lower: The tumor cells were weakly positive for chromogranin A by immunohistochemical staining (x100) while strongly positive for synaptophysin (Right Lower, x100).
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He presented with a metachronous metastatic lesion in the right adrenal gland (Fig. 4), which was resected, measuring 3 x 2 x 2 cm, with a Ki-67 index of 15-20%, and is CD56+, synaptophysin+ and chromogranin A+.