PMC4247116_01
Gross images and hematoxylin and eosin (H&E)-stained microscopic images of the primary adrenocortical carcinosarcoma. (A) A computed tomography scan demonstrates a 7.6x5.1-cm well-demarcated and peripherally enhanced left adrenal mass impinging on the pancreas and the spleen, without parenchymal invasion into the kidney. (B) Gross image of the cut surface of the adrenocortical carcinosarcoma shows a circumscribed mass, predominantly comprising paler, firm tissue, with partially yellow tissue. (C) A compressed rim of normal adrenal gland is apparent adjacent to the tumor capsule. (D) The tumor comprises of spindle cell and epithelial components (H&E staining; magnification, x100). (E) Carcinomatous cells exhibit highly atypical nuclei and an abundant eosinophilic cytoplasm (H&E staining; magnification, x200). (F) Spindle-shaped tumor cells reveal highly pleomorphic nuclei (H&E staining; magnification, x200).
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A dynamic, contrast-enhanced abdominal computed tomography scan showed a 7.6x5.1-cm well-demarcated and peripherally enhanced left adrenal mass that was impinging on the pancreas and the spleen, without parenchymal invasion into the kidney (Fig. 1A). The majority of the lesion was pale, however, certain regions (~30% of the tumor area) were bright yellow (Fig. 1B). There was a small quantity of the residual adrenal gland, which appeared to be laminated at the periphery of the tumor (Fig. 1C). The tumor comprised of epithelial and spindle cell components that were multifocally intermingled (Fig. 1D and E). These cells showed highly atypical nuclei, and an abundant eosinophilic cytoplasm and usually possessed large, prominent nucleoli (Fig. 1E). Furthermore, spindle-shaped tumor cells were observed to be arranged in a haphazard fascicular pattern with highly pleomorphic nuclei (Fig. 1F).
Immunohistochemical staining of the primary adrenocortical carcinosarcoma. (A) Carcinomatous and sarcomatous cells positive for cluster of differentiation 56 (magnification, x200). Cytoplasm of the sarcomatous cells positive for (B) Bcl-2 (magnification, x200) and (C) neuron specific enolase (magnification, x100). (D) Carcinomatous and sarcomatous cells positive for Ki-67 (x100).
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Cluster of differentiation (CD)56 demonstrated diffuse positivity in the epithelial cells and spindle areas (Fig. 2A). Bcl-2 showed focal positivity in the sarcomatous areas (Fig. 2B) and CD34 was weakly positive. NSE was only weakly positive in sarcomatous components (Fig. 2C) and Ki-67 demonstrated 70% positivity in the two components (Fig. 2D).