PMC9261228_01
Contrast-enhanced computed tomography (CT), venous phase, axial view
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Fig1
A T2-weighted, coronal view. B T2-weighted, axial view. C Fat suppressed sequence, axial view. D Gadolinium enhanced T1, axial view. The formation shows strongly heterogeneous MR-characteristic, mainly cystic (T2-hyperintense) and with hemorrhagic content (T1-hyperintense); there is presence of a relatively thick capsule (possibly a pseudocapsule due to a highly thin and peripherally dislocated parenchyma) and fine septa. After application of contrast material, there is an amplification of the signal at the periphery (capsule/pseudocapsule) of the lesion and in the septa. Mass effect on the upper pole of the right kidney, right hepatic lobe, inferior vena cava, and right renal vein is present
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Fig2
Abdominal ultrasound and magnetic resonance imaging (MRI) were performed and demonstrated decrease of the cyst dimensions to 52 x 50 mm (Fig. 2).
Intraoperative view of the cystic lesion; RK:right kidney; IVC:inferior vena cava; Tu:tumor; RRV:right renal vein
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Fig3
Despite the initial plan to perform cystectomy, the intimate adhesion of the lesion to the adrenal gland and vena cava inferior necessitated en-bloc adrenalectomy to prevent spillage of the cyst content (Fig. 3).
Macroscopic appearance:shining surface, intact adrenal gland:above; Adr:adrenal gland; Tu:tumor
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Fig4
The tumor appeared black-brown with a shining surface due to its cellular pigmentation (Fig. 4).
A Tumor formation (black arrow) without connection to the adrenal gland (blue arrow), hematoxylin and eosin stain, original magnification 14x. B Large field of necrosis (arrow) in the central area of the tumor, hematoxylin and eosin stain, original magnification 20x. C Psammoma body calcium aggregates (arrows) within the tumor parenchyma, hematoxylin and eosin stain, original magnification 80x. D Hypercellular tumor parenchyma with multiple pigmented Schwan cells, hematoxylin and eosin stain, original magnification 200x
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Fig5
The adrenal gland was intact with no tumor infiltration (Fig. 5).
A Multiple mitotic figures (arrows), hematoxylin and eosin stain, original magnification 400x. B Strong immunopositivity for anti-HMB45, original magnification 100x. C Strong immunopositivity for anti-Melan A, original magnification 100x. D Strong immunopositivity for anti-S100, original magnification 100x
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Fig6
Individual cells expressed inhibin alpha, Chromogranin A and Ki 67 to about 10 to 15% (Fig. 6).