PMC5817380_01
Histology staining of tumor.
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fig2
Intraoperative biopsy showed that the tumor contained lobular growth of small round cells with uniform hyperchromatic chromatin, inconspicuous nucleoli, and scant fibrillary cytoplasm, with rare mitotic figures present (Figure 2(a)). The cells stained positive for chromogranin, synaptophysin, and CD56 on histology, with S100 highlighting the periphery of the clusters (Figure 2(b)). Final confirmation was done with ACTH-staining, which was positive in the tumor cells (Figure 2(c)).
Cortisol and ACTH changes before and after operation. The x-axis details the day since initial admission to our hospital. Day 19 or the red line is the resection of the esthesioneuroblastoma. The left y-axis is the level of plasma adrenocorticotropic hormone (ACTH (pmol/L)); the right y-axis is the level of plasma cortisol (Cort-S (nmol/L)). At his outpatient follow-up, 0.25 mg ACTH stimulation tests were done in clinic with assessment of endogenous cortisol production (plasma cortisol level measured at baseline and 30 and 60 minutes after ACTH stimulation).
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fig3
Although his hypokalemia has resolved, his endogenous cortisol production is improving but has not yet recovered completely (Figure 3).