PMC4899568_01
48-year-old male with pheochromocytoma. Axial, contrast-enhanced CT demonstrated a 6.8cm left adrenal mass (arrow) with predominantly peripheral enhancement and central necrosis (arrow). The lesion implied mass effect and posterior displacement of the left kidney.
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The CT demonstrated a large 6.8cm left adrenal mass with predominantly peripheral enhancement and central areas of low attenuation, presumed to represent necrosis (Fig. 1).
48-year-old male with pheochromocytoma. Axial (A) and coronal (C) in-phase MR images showed the heterogeneous left adrenal mass (arrows). During the axial (B) and coronal (D) out-of-phase images, there was no loss of signal in the mass (arrows).
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The lesion did not demonstrate any signal loss on out-of-phase imaging, as would be expected with lipid-rich lesions such as adenomas (Fig. 2).
48-year-old male with pheochromocytoma. Axial, T2-weighted MR showed a central area of hyperintensity (arrow) within the left adrenal mass.
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On the T2-weighted sequence, the lesion was heterogeneous but showed large regions of hyperintensity (Fig. 3).
48-year-old male with pheochromocytoma. Four hours following I-123 MIBG administration, anterior and posterior whole-body planar images (A) and fused SPECT-CT images (B) revealed focal concentrated uptake of MIBG (arrows) within the left adrenal gland consistent with a pheochromocytoma. No other areas of focal MIBG activity were seen to suggest metastasis. Physiologic uptake was identified within the salivary glands, liver, and urinary bladder on the planar images.
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The study demonstrated that the left adrenal mass was strongly MIBG-avid (Fig. 4), supporting the clinical diagnosis of pheochromocytoma.
48-year-old male with pheochromocytoma. Gross pathology (A) revealed an encapsulated red-brown pheochromocytoma, measuring 7cm and 139g. Hematoxylin and eosin stain (B) revealed pleomorphic nuclei with characteristic nests of cells "zellballen" and abundant cytoplasm.
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Gross pathology (Fig. 5a) revealed an encapsulated rubbery, red-brown mass arising from the adrenal medulla with histologic findings (Fig. 5b) supporting the diagnosis of pheochromocytoma.