PMC7263850_01
Preoperative abdominal contrast-enhanced CT scan showed a well-circumscribed heterogeneously mass in the right suprarenal areal (arrow). (A) Axial sections and (B) coronal sections.
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Contrast-enhanced CT showed moderate enhancement with irregular non-enhanced areas within, suggesting malignancy (Figure 1).
Macroscopic features of the tumor showed a well-circumscribed and partially encapsulated solid tumor measuring 5.5x5x3.2 cm in maximum dimension. The normal adrenal gland was displaced by the tumor and presented at the edge of the tumor.
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The normal adrenal gland was displaced by the tumor and presented at the edge of the tumor (Figure 2).
Microscopic details of the tumor. (A) The interlacing bundle and fascicles of the tumor (arrowhead) and compressed adrenal tissue (arrow). (H&E, x 100). (B) Leiomyosarcoma with nuclear pleomorphism and giant cell formation with mitotic activity in the range of 8-10 mitoses/10 high power fields (H&E, x 400). (C) Immunohistochemical staining for desmin is positive (x 100). (D) Immunohistochemical examinations showed strong immunoreactivity for H-caldesmon (x 100).
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Microscopically, the adrenal gland was compressed, but not invaded by the spindle cell tumor, which was arranged in interlacing fascicles (Figure 3A). Tumor cells were elongated with eosinophilic fibrillary cytoplasm with marked pleomorphism of the nuclei, with up to 8-10 mitoses/10 high power fields (Figure 3B). An immunohistochemical examination showed positive staining for SMA, desmin (Figure 3C), vimentin, and H-caldesmon (Figure 3D), and negative staining for S-100, CD 117, Dog-1, ER and PR.