PMC8716616_01
(A, B) Haematoxylin and eosin staining of a tumour section (A: x10 magnification; B: x40 magnification). The pathological diagnosis was adrenal angiogenic malignant tumour with massive necrosis. (C, D) Immunohistochemistry showed positive reactivity for CD31 (C) and CD34 (D) in the tumour cells, indicating that they were of endothelial origin (x40 magnification).
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Postoperative pathology revealed an adrenal angiogenic malignant tumour with massive necrosis (combined with morphology and immunohistochemistry, an epithelioid angiosarcoma was also considered), and a negative margin (R0 resection). ( Figures 1A, B ). The results of immunohistochemistry were as follows: CD34 (+), CD31 (+), ERG (partially weak+), FLI-1 (partially weak+), CK (+), CK7 (+), CK20 (-), CD56 (-), CgA (-), Syn (-), SMA (-), S-100 (-), desmin (-), HMB 45 (-), melan-A (-), and Ki67 (+, 20%) ( Figures 1C, D ).
Seven months after operation, positron emission tomography/computed tomography was performed. (A, B) The soft tissue mass in the operative area was accompanied by an abnormal increase of fluorodeoxyglucose metabolism (maximum standardized uptake value, 21.0). (E, F) The larger lymph nodes were located in the 8R area (4.2x 1.9 cm, maximum standardized uptake value, 7.9). Computed tomography during treatment showed that the tumour lesions disappeared in the arterial phase and the mediastinal and mediastinal-hilar lymph nodes were significantly reduced or had disappeared. (C, G) after two cycles of chemotherapy. (D, H) after six cycles of chemotherapy.
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Furthermore, the lesion involved the left renal upper pole and left renal fascia, and the fat space around the lesion was slightly blurred ( Figures 2A, B ). Meanwhile, multiple enlarged lymph nodes were found in the bilateral clavicular area, bilateral mediastinal-hilar, mediastinum, bilateral anterior diaphragm, left retrocrural space, hepatic hilum, retroperitoneum (perirenal and pericaval) and left inguinal area, and the larger ones were located in the 8R area (4.2x 1.9 cm, maximum standardized uptake value, 7.9,  Figures 2E, F ). At that time (after two cycles of chemotherapy), a CT scan showed a disappearance of the soft tissue tumour lesions in the operation area and a significant reduction or disappearance of the mediastinal and mediastinal-hilar lymph nodes ( Figures 2C, G ). Figures 2D, H ). Finally, he had achieved a CR.