PMC5494063_01
Gadolinium enhanced MRI abdomen axial and coronal view showing right adrenal mass and IVC thrombosis.
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CECT abdomen and gadolinium-contrast MRI abdomen revealed 6 x 4 cm heterogeneously enhancing mass with delayed washout suggestive of right adrenal malignancy with invasion to right IVC wall leading to narrowing and presence of nonenhancing IVC thrombus extending from the level of renal veins to the level of confluence with hepatic veins (Figure 1).
Pheochromocytoma in cut section with IVC thrombus (shown by arrow).
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On cut section, the mass was flesh coloured with central pale area containing some hemorrhagic areas (Figure 2).
Biopsy showing oval to polygonal tumor cells with abundant granular eosinophilic to clear cytoplasm and oval nucleus. The nests of tumor cells (zellballen pattern) are separated by sustentacular cells ((a) x200; (b) x400).
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Histopathology of the mass turned out to be pheochromocytoma with thrombus revealing fibroadipose tissue with fibrin (Figure 3).