PMC6175743_01
Ultrasound mass showed signs of early cholecystitis.
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On imaging, a right upper quadrant ultrasound showed signs of early cholecystitis (Fig. 1) and computed tomography of the abdomen showed gallstones and distended liver bile ducts, distended gallbladder with wall thickening, edema, and a mild surrounding inflammation consistent with the ultrasound findings (Fig. 2).
(a) Low power photomicrograph of the lesion in the center of the image. Part of the cystic duct lumen is seen at the right edge of the micrograph (hematoxylin and eosin stain, original magnification x40). (b) Medium power photomicrograph demonstrating the characteristic nested growth pattern of small, monomorphic cells that contain pale-to-eosinophilic foamy cytoplasm (hematoxylin and eosin stain, original magnification x200). (c) Low power photomicrograph revealing diffuse and strong immunopositivity for synaptophysin (original magnification x40), supporting the morphologic impression of neuroendocrine differentiation.
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In all, the morphologic and immunophenotypic findings were most consistent with an incidental paraganglioma (Fig. 3a-c).
Non-contrast CT showing a 1.5 cm nodule involving the adrenal gland with a Hounsfield unit density of 14. On MRI, this was interpreted as a benign adenoma.
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The scan demonstrated a 1.5 cm right adrenal mass with a Hounsfield unit of 14 (Fig. 4).