PMC5778720_01
Multiphase CECT showing right adrenal mass with maximum diameter of 9.9 cm (a) unenhanced phase (HU of 45.3) with central areas of necrosis, (b) early arterial phase showing bright enhancement of mass (HU-158.2), (c) early venous phase (HU-98.6) showing washout as compared to early arterial phase, (d) 15-min delayed phase (HU-61.2) showing washout. CECT: contrast-enhanced computed tomography, HU: Hounsfield unit. Technique: 64-slice multidetector CT system (Brilliance 64, Philips Healthcare, Best, and the Netherlands) with imaging done at baseline, 20 s (early arterial), 1 min (early venous), and 15 min (delayed)
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F1
CECT [Figure 1] showed rounded right suprarenal mass with central areas of necrosis and had a size of 9.9 cm (maximum size on axial images).
(a) 18F-FDG avid lesion in the right adrenal mass (SUVmax 4.52), (b) 18F-FDG avid lesion in the left gluteal region (SUVmax-5.5), (c) 18F-FDG avid lesion in the left scapular region (SUVmax 4.6), (d and e) Coronal sections of FDG and CECT showing all three lesions (arrows), 18F-FDG: 18-flurodeoxyglucose positron emission tomography/computed tomography, SUVmax: maximum standardized uptake value, CECT: contrast-enhanced computed tomography. Technique: whole-body 18-F-FDG PET/CT was performed in a BGO plus, full ring PET/CT scanner with intravascular contrast injection
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F2
On morning 8 am cortisol (13.85 mug/dl, normal range <30 mug/dl) and overnight dexamethasone suppression cortisol (0.8 mug/dl, normal range <1.8 mug/dl) ruled out the secretory adrenal cortical carcinoma. 18-flurodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed [Figure 2] multiple hypermetabolic lesions at right adrenal mass (maximum standardized uptake value [SUVmax]: 4.52), lytic lesion in the left scapula (SUVmax: 4.46), and soft tissue mass (7.3 cm) noted in the left gluteal region eroding the left iliac bone, acetabulum, inferior pubic rami and possibly invading the hip joint (SUVmax-5.5).
(a) Hematoxylin and eosin staining under light microscopy (x40) showing tumor cells arranged as nests separated by thin vascular septae with central round nucleus and moderate eosinophilic cytoplasm, (b) on immunohistochemistry, tumor cells showed positivity for TFE suggestive of alveolar soft part sarcoma
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F3
Cells were discohesive with central round nucleus and moderate eosinophilic cytoplasm on microscopy [Figure 3a]. TFE [Figure 3b] and epithelial membrane antigen (focal) and were negative for cytokeratin, synaptophysin, inhibin, melan-A, and PAX8 diagnostic of alveolar soft part sarcoma (ASPS).