PMC4392357_01
Computed tomography of the 7 cm right adrenal mass (arrow).
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Abdominal computed tomography (CT) revealed a 7.0 cm lesion at the right adrenal gland (Fig. 1), and hormone testing revealed excessive serum cortisol (with loss of the diurnal pattern), elevated urine free cortisol, and a non-suppressible response to the dexamethasone test (Table 1).
The resected specimen from the first recurrence. (A) Macroscopic findings reveal a light-gray 7.7 cm mass. (B) Microscopic finding reveal large eosinophilic cells with highly atypical nuclei, and more than 5 mitoses per 50 high-power fields (hematoxylin and eosin, x2).
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Therefore, we performed surgical removal of the right adrenal tumor, and histopathological examination revealed large eosinophilic cells with highly atypical nuclei and more than 5 mitoses per 50 high-power fields (Fig. 2).
Magnetic resonance imaging of the liver reveals (A) a 10 mm mass in segment 5, and (B) a 26 mm mass in segment 7.
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Magnetic resonance imaging of the liver confirmed the presence of the 26 mm mass in segment 7 and also revealed a 10 mm mass in segment 5 (Fig. 3).
The resected specimen from the second recurrence. (A) Macroscopic findings reveal a light-gray 2.8 cm mass. (B) Microscopic finding reveal the features of the primary adrenal cortical tumor, which was composed of large eosinophilic cells with highly atypical nuclei (hematoxylin and eosin, x40). Immunohistochemical staining reveals that the tumor cells were not immunoreactive for hepatocyte paraffin 1 (a monoclonal anti-hepatocyte antibody) (C), although the cells were diffusely immunoreactive for inhibin alpha (D).
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Therefore, the patient underwent partial resection of segment 3, and histopathological assessment of the specimens revealed that the mass was liver metastasis of the ACC (Fig. 4).