PMC6320243_01
Clinical course. Dx, diagnosis; HIPEC, hyperthermic intraperitoneal chemotherapy.
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F1
A 48-year-old woman initially came to Mary Washington Hospital in December 2010 with blurry vision, fatigue, weight gain, muscle weakness, hair loss, increased abdominal girth, abdominal striae, and indurated swelling on the back of her neck (Fig. 1).
Radiologic response after the treatments. (A) Upper panel: Recurrent ACC on the surgical bed, indicated with circle. Lower panel: Subcentimeter lung lesion indicated at arrow. (B) Upper panel: Postsurgical change in the original recurrent site. Lower panel: enlarged lung lesion indicated at arrow. (C) Representative image showing no evidence of disease and postsurgical change.
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F2
Unfortunately, 4 years later, a recurrence developed, identified by fluorodeoxyglucose-positron emission tomography scan (3 x 3 cm; Fig. 2, panel I), in the prior surgical bed. Surveillance CT scans of the chest indicated a left lower-lung nodule that grew slowly from 3 x 3 mm to 8 x 7 mm (Fig. 2, panels I and II). ACC metastases were confirmed (Fig. 3). After this procedure, there was no evidence of disease (Fig. 2, panel III).
Pathologic evidence of ACC metastases to lung. (A) Representative hematoxylin and eosin staining of resected lung lesion, indicated on the right; normal lung parenchyma is evident on the left (magnification, x4). The enlarged section shows sheets of polygonal tumor cells with granular to clear cytoplasm, some nuclear pleomorphism, and very low mitotic rate (magnification, x10). (B) Representative immunohistochemical (IHC) staining showing diffuse inhibin expression (magnification, x10). (C) Representative IHC staining showing a patchy area positive for MELAN-A protein expression (magnification, x10). (D) Representative IHC staining showing S-100 protein expression in tumor tissue (magnification, x10).
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F3
ACC metastases were confirmed (Fig. 3). After this procedure, there was no evidence of disease (Fig. 2, panel III).