PMC5178330_01
Imaging findings of the patient. (a) Computed tomography shows two adjacent round solid masses in the left suprarenal fossa: a 4 cm low-density mass (arrowhead) and another 1.8 cm enhancing mass (arrow). (b) On T2 magnetic resonance imaging, the 4 cm mass (arrowhead) showed intermediate signal intensity with subtle peripheral and delayed centripetal enhancement in the arterial phase, suggesting a neurogenic tumor. In contrast, the 1.8 cm mass (arrow) showed similar intensity to the spleen.
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Abdominal computed tomography (CT) revealed a 4 cm low-density mass and another 1.8 cm enhancing mass in the left suprarenal fossa, both of which were considered to have originated from the adrenal gland or retroperitoneal soft tissue (Figure 1(a)). An additional magnetic resonance imaging (MRI) scan showed two abutting masses on the left adrenal gland (Figure 1(b)).
Histological findings of the patient. (a) The gross specimen shows a 2 cm dark-brownish mass (arrow) and a 4.5 cm whitish solid mass (arrowhead) within the adrenal cortex. (b) The 2 cm mass showed abundant eosinophilic, granular cytoplasm with variable sized brown pigments (40x). (c) The 4.5 cm mass showed fascicles of Schwann-like cells and some clusters of ganglion cells (40x).
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Grossly, two adjacent but uncombined well-demarcated oval-shaped masses were confined within the yellowish adrenal cortex (Figure 2(a)). Microscopically, it was composed of compactly arranged polygonal cells with mild-to-moderate nuclear pleomorphism and abundant eosinophilic granular cytoplasm (Figure 2(b)). The larger mass (4.5 x 3.5 x 3.0 cm) was whitish to light yellowish in color, and the consistency was firm (Figure 2(a)). Microscopically, the tumor cells were arranged in loosely fascicular pattern (Figure 2(c)), and they showed wavy nuclei, inconspicuous nucleoli, and elongated cytoplasm.