PMC5109567_01
Computed tomography and iodine-131-meta-iodobenzylguanidine (MIBG) scintigraphy. (A) Abdominal computed tomography showing a huge right adrenal tumor, covered by a film, and with a heterogeneous internal structure. (B) MIBG scintigraphy showing an area of accumulation in the right adrenal tumor.
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Computed tomography of the abdomen was performed and revealed a huge right adrenal mass (Fig. 1A) with a heterogeneous internal structure. Iodine-131-meta -iodobenzylguanidine (MIBG) scintigraphy then demonstrated an accumulation in this right adrenal tumor (Fig. 1B).
Macroscopic findings of the resected tumor. Image showing a tumor measuring 5.0x5.0x5.5 cm. The divided surface is brown with a serum-like fluid present and the border of normal and tumor tissue is clearly recognized.
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The resected mass was well encapsulated and measured 5.0x5.0x5.5 cm in size (Fig. 2).
Pathological findings of the resected specimen. (A) Histological examination by Hematoxylin and Eosin staining showing proliferative tumor cells in the so-called "zellballen" pattern, mimicking adrenal medullary cells (high-power micrograph). (B) Most tumor cells are immunoreactive for somatostatin.
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Representative histopathological findings are summarized in Fig. 3A. Somatostatin, chromogranin, synaptophysin, and neuron specific gamma-enolase were all immunohistochemically positive in tumor cells but neurofilament negative (Fig. 3B; data only shown for somatostatin).
Clinical Course. The clinical course of fasting blood glucose is shown; on admission, Humulin R (10-10-10) and Humulin N (0-0-0-10) was continued from the previous hospital and adjusted as shown. Doxazosin 1 mg was initiated on day 10 of admission and carvedilol 10 mg was initiated on day 25, reaching the final doses of 4 mg and 20 mg, respectively, before surgery. On day 38, laparoscopic adrenalectomy was performed and the adrenal tumor removed. After surgery, 4-10 % glucose was administrated for 5 days and the insulin and adrenergic blockers were discontinued. FBS: fasting blood sugar
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Fig. 4 shows the clinical course during hospitalization.