PMC3676950_01
CT scan showing a hemangioblastoma in the right temporal lobe in the noncontrast and contrast series.
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fig1
These tests revealed a mass in the right temporal lobe (Figures 1(a) and 1(b)).
CT scan of the abdomen showing a mass in the left adrenal gland in the noncontrast and contrast series.
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fig2
This time, she presented with weakness, palpitations, and nausea, and an abdominal CT was performed both with and without contrast (Figures 2(a) and 2(b)).
The lobulated hypercellular tumor is composed of large, polygonal cells with a low nuclear/cytoplasmic ratio and a grainy basophilic cytoplasm. The tumor is encircled by cells that form the cortical region of the adrenal gland. The mass is well demarcated, with no capsule or pseudocapsule.
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fig3
For this reason, and because of the absence of clinical signs typical of pheochromocytoma, the tumor was subjected to further immunohistochemical analyses (Figures 3, 4, 5, 6, and 7).
There is no tumor cell mitosis. There is no necrosis, no significant pleomorphism of the cells or their nuclei (including spindle-shaped cells, hyperchromasia of the nuclei, and large nucleoli), no tumor infiltration of the adrenal gland cortical tissues, no vascular or perineural invasion, and no invasion into the adrenal gland capsule (including the periadrenal tissues).
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fig4
For this reason, and because of the absence of clinical signs typical of pheochromocytoma, the tumor was subjected to further immunohistochemical analyses (Figures 3, 4, 5, 6, and 7).
Diffuse cytoplasmic staining of tumor cells with an antibody specific for chromogranin A. Immunoperoxidase stain; mag x40.
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fig5
For this reason, and because of the absence of clinical signs typical of pheochromocytoma, the tumor was subjected to further immunohistochemical analyses (Figures 3, 4, 5, 6, and 7).
The proliferation index of Ki-67 (clone MIB-1) detection in the tumor is very low (<1%).
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fig6
For this reason, and because of the absence of clinical signs typical of pheochromocytoma, the tumor was subjected to further immunohistochemical analyses (Figures 3, 4, 5, 6, and 7).
The tumor cells are negative for calretinin.
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fig7
For this reason, and because of the absence of clinical signs typical of pheochromocytoma, the tumor was subjected to further immunohistochemical analyses (Figures 3, 4, 5, 6, and 7).
PMC3676950_02
Genealogical tree.
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fig8
During the enquiry about the family history (Figure 8), it was revealed that the patient's mother had died from an intracerebral hemorrhage at the age of 41.