PMC3025878_01
STIR and LGE images. A, four chamber view, T2-weighted image showing thickening of lateral wall with edema (white arrows); B, post-surgical follow-up T2-weighted images showing normalization of wall thickness and regression of edema; C, post-contrast images showing diffuse myocardial enhancement (black arrows); D, post-surgical follow-up post-contrast images showing regression of myocardial enhancement.
1532-429X-13-4-1.jpg
PMC3025878_01_1532-429X-13-4-1.jpg
F1
Non invasive myocardial tissue characterization with T2-weigthed imaging demonstrated myocardial edema of the postero-lateral segments, whereas the T1-weighted late gadolinium enhancement (LGE) images showed diffuse and patchy myocardial enhancement, both consistent with acute non-ischemic myocardial damage (Figure 1A, C). In addition, a large incidental mass was identified in the left suprarenal gland, suggesting pheochromocytoma (Figure 1b). Three months later she underwent a follow-up CMR, showing normalization of wall thickness (Additional file 2), regression of both myocardial edema and LGE (Figure 1B, D).
Pre-surgical MR and macroscopic anatomy images. A, abdomen MRI showing large left surrenal mass (white arrow); B, pheochromocytoma after surgical resection.
1532-429X-13-4-2.jpg
PMC3025878_01_1532-429X-13-4-2.jpg
F2
The diagnosis of pheochromocytoma was therefore confirmed and the patient underwent surgical resection of the adrenal mass (Figure 2B).
Histology data. A, low magnification showing the watershed between tumor (T) and normal gland (N), and the tumoral "pseudocapsule"(C). Organoid ( alveolar) arrangement of tumor cells with nests or cords of poligonal eosinophilic tumor cells in a highly vascularised stroma.B, tumor cells showing finely granular, pinkish-brown, delicate cytoplasm, ovoid nuclei with small regular nucleoli. Haemosiderin from small intratumor haemorrages is shown at the top. C, hyaline globules are present in 47% of pheochromocytomas: they are PAS positive, diastase resistant eosinophilic rounded masses of degenerated cytoplasmatic organules. D, synaptophysin immunostain showing intense cytoplasmatic positivity of tumor cells (red), a venule is shown on the top for negative comparison.
1532-429X-13-4-3.jpg
PMC3025878_01_1532-429X-13-4-3.jpg
F3
The histological examination (Figure 3) confirmed the diagnosis of secreting pheochromocytoma.