PMC6590562_01
(a) Gross photograph: brain, subarachnoid hemorrhage. (b) Gross photograph: circle of Willis, ruptured berry aneurysm. (c) Hematoxylin & Eosin Stain (100x): adrenal gland with tumor in the medulla showing nesting pattern. (d) Hematoxylin & Eosin Stain (400x): tumor cells from pheochromocytoma showing large polygonal tumor cells with amphophilic cytoplasm.
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Examination of brain showed subarachnoid hemorrhage (Figure 1(a)). Dissection of the intracranial vasculature revealed a ruptured berry aneurysm at the junction of right cerebral and anterior communicating arteries (Figure 1(b)). Based on morphology, the adrenal tumor was diagnosed as pheochromocytoma (Figures 1(c) and 1(d)).
(a-b) CT abdomen and pelvis with contrast in 2006 demonstrating a large right adrenal mass with a hypodense center (a) venous phase and (b) delayed imaging. (c) Noncontrast CT abdomen pelvis in 2013 showing interval increase in size of the right adrenal mass to 3.7 x 3.2 cm from 2.3 x 1.9 cm.
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Prior work-up by CT abdomen and pelvis imaging in 2006 demonstrated an enhancing right adrenal mass with a hypodense center, likely necrosis, without demonstration of washout (Figures 2(a) and 2(b)). The mass had an interval increase from 2007 to 2013 from 2.8 x 2.2 cm to 3.7 x 3.2 cm (Figure 2(c)).