PMC10225629_01
Selected window images of axial, coronal plain abdomen CT scan soft tissue demonstrating a heterogeneous adrenal mass measuring 10.6x6.4x11.0cm, which abutted and compressed the liver parenchyma, right renal and IVC.
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The right posterior liver, portal vein and upper pole of the right kidney were displayed ( Figure 1 ).
The MRI findings of primary adrenal sarcoma. (A) coronal T2-weighted MR image, (B) axial T1-weighted MR image, (C) axial fat suppression T2-weighted MR image, (D, E) The tumor showed heterogeneous high signal intensity on DWI and low signal intensity on ADC map, (F-I) axial fat suppression T1-weighted MR imaging (F), and Gadolinium-enhanced T1-weighted MR mages at arterial (G), portal (H) and delayed phases (I), the tumor exhibited heterogeneous enhancement and no enhancement in the central scar.
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A follow-up MRI ( Figure 2 ) revealed a 10.2x6.5x10.5 cm oval tumor in the right suprarenal region, with a high-low mixed sign on T1WI and slightly high signals on fat suppression T2WI sequence.
Microscopic findings of primary adrenal epithelioid sarcoma. (A) hematoxylin-eosin staining shows that polygonal cells were distributed separately, scattered, in clusters orpatches, with large nuclei and prominent nucleoli (magnification, x100); (B) immunochemical staining shows nuclear positivity for INI-1 (magnification, x400).
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Immunohistochemical analysis showed that tumor cells were positive for CK8/18, EMA, vimentin, CD10, Desmin, CD34, SMARCB1/INI-1, SOX-2, SALL4, p53 and Ki-67, while SMARCA4/BRG1, SMARCA 2(BRM), Cr, S-100, HMB-45, Pax-2, Pax-8, WT-1, CK5/6, Melan-A, CK-7, Alpha-inhibin, RCC, MyoD1, Myogenin and SMA were negative ( Figure 3 ).