PMC5954341_01
Section from the thigh mass (10x, H&E) shows a hypercellular tumor, with spindle cells in sheets and fascicular arrangement.. The spindle-shaped nuclei have clumped chromatin. These features are compatible with a malignant peripheral nerve sheath tumor.
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f1
Given the clinical history of NF-1 and the lack of immunoreactivity for all performed markers for this tumor was most compatible with an undifferentiated MPNST ( Figure 1) AMRI of the abdomen, to further evaluate the adrenal mass, revealed 2 small left adrenal gland lesions in the medial and lateral limbs.
The area on the right shows two populations of tumor cells that are intermingling with each other, representing a collision tumor (20x, H&E).. One population is composed of hypercellular malignant spindle cells with hyperchromatic nuclei (blue arrow) that are infiltrating the adjacent adrenal tissue. This is morphologically compatible with malignant peripheral nerve sheath tumor. The other population is composed of the nests of polygonal cells with abundant eosinophilic cytoplasm (green arrow), compatible with pheochromocytoma.
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f2
The patient underwent a laparoscopic adrenalectomy, with gross pathological exams revealing two tumor nodules and with a histological exam revealing an intermixed "cancer to cancer metastasis" involving pheochromocytoma and sarcoma, consistent with MPNST( Figure 2).