PMC5219631_01
Radiological findings. (A, B) Abdominal computed tomography (CT) (A, plain image; B, contrast-enhanced image) performed in October 2002 showing a 1.5-cm tumor with calcification in the pancreas (long arrow), a 1.0-cm tumor in the right adrenal gland (arrow head) and a 2.0-cm tumor in the left adrenal gland (short arrow). (C) Chest CT (plain image) performed in October 2010 showing a 1.5-cm tumor in segment 4 of the middle lobe of the right lung (arrow). (D) Abdominal CT (contrast-enhanced image) performed in April 2013 showing a 4.0-cm tumor in the left adrenal gland (arrow).
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Routine CT performed in October 2010 showed a 1.5-cm tumor in the middle lobe (section 4) of her right lung (Fig. 1C). April 2013 revealed no recurrent LAC and no changes in her parathyroid, pancreatic, and right adrenal tumors, with the exception of an enlarged left adrenal tumor (4 cm) (Fig. 1D).
Histological findings of the resected middle lobe of the right lung. (A) The gross appearance of the cut surface of the right lower lung shows a 1.8-cm tumor. (B-G) Proliferation of relatively well-differentiated atypical glands was observed (B, C; hematoxylin and eosin staining) indicating well-differentiated adenocarcinoma (acinar adenocarcinoma). The cytoplasm of the tumor cells was immunohistochemically positive for napsin A (D), and the tumor cell nuclei were positive for thyroid transcription factor-1 (E). Cell nuclei of the tumor cells were immunohistochemically negative for menin (F), whereas those of adjacent non-tumoral tissues were positive (G).
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The histopathological features were consistent with a well-differentiated adenocarcinoma (Fig. 2).
Histological findings of the resected left adrenal gland. (A) The gross appearance of the cut surface of the left adrenal gland shows a 4.2-cm tumor. (B-I) The tumor consisted mainly of clear cells and compact cells (B; hematoxylin and eosin staining). The tumor contained a portion of coagulative necrosis and showed capsular invasion (C, D; hematoxylin and eosin staining). The immunostained nuclei of the tumor cells were positive for steroidogenic factor 1 (E), and the cytoplasm of the tumor cells showed positive immunostaining for 3beta-hydroxysteroid dehydrogenase (F). Approximately 2% of the tumor cells were positive for p53 (G). Cell nuclei of the tumor cells were immunohistochemically negative for menin (H), whereas those of adjacent non-tumoral tissues were positive (I).
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The tumor, which consisted mainly of clear cells and compact cells, exhibited coagulative necrosis, capsular invasion, nuclear atypia, and mitosis (Fig. 3); the Ki-67 labeling index was 8% in the hot spot.