PMC3991056_01
Coronal reformatted contrast enhanced CT showing the large right adrenal mass. Note the extrinsic compression of the liver and inferior vena cava and inferior displacement of the right kidney. Figure 1B: Axial CT at the level of L 1 vertebra. Note the largely hypo-dense mass, indicating the lipid content. The iso-dense areas represent the myeloproliferative tissues.
qmj-2013-007-g001.jpg
PMC3991056_01_qmj-2013-007-g001.jpg
fig1
It was located in the retroperitoneal space, markedly displacing the right kidney downwards, the liver, gall bladder and part of the transverse colon upwards, and the inferior vena cava, head of pancreas and right renal vessels stretched along its medial margin (Figure 1A & 1B).
Axial tbl1 weighted MRI showing most of the mass to be of high signal intensity, consistent with fat. Figure 2B: Axial tbl1 weighted fat saturated post-gadolinium MRI image. Note that the areas of the mass previously showing high intensity are hypo-intense.
qmj-2013-007-g002.jpg
PMC3991056_01_qmj-2013-007-g002.jpg
fig2
Magnetic resonance imaging (MRI) confirmed the CT findings and showed in the fat suppression sequences the heterogeneous nature of the mass and its large lipid content (Figure 2A & 2B).
Operative photographs of the large right adrenal mass displacing the bowels and the right kidney.
qmj-2013-007-g003.jpg
PMC3991056_01_qmj-2013-007-g003.jpg
fig3
The right kidney was displaced inferiorly and the inferior vena cava medially and the tumor adherent with soft adhesions to the surrounding structures (Figure 3A & 3B).
Gross appearance of the tumour after resection.
qmj-2013-007-g004.jpg
PMC3991056_01_qmj-2013-007-g004.jpg
fig4
Gross and microscopic findings: Gross examination of the surgically excised specimen showed 28 cm x 18 cm x 12 cm thinly encapsulated tumor weighing 3850 grams, which was yellow with a few brown areas on its external surface (Figure 4).
Histological examination of the mass shows islands of normal hematopoietic cells, such as megakaryocytes associated with stromal fat cells.
qmj-2013-007-g005.jpg
PMC3991056_01_qmj-2013-007-g005.jpg
fig5
In a circumscribed area, islands of normal haemopoietic elements such as erythroblasts, immature lymphoid cells and megakaryocytes were seen (Figure 5).