PMC7103033_01
CT abdomen without contrast showing a large, right suprarenal vs. adrenal mass (arrow).
CRIM2020-5131736.001.jpg
PMC7103033_01_CRIM2020-5131736.001.jpg
fig1
Computed tomography (CT) scan of the abdomen without contrast revealed a right suprarenal vs. renal mass measuring 16 x 17 x 20 cm (Figure 1).
MRI of the abdomen showing a large, right abdominal mass from the unclear origin (arrow).
CRIM2020-5131736.002.jpg
PMC7103033_01_CRIM2020-5131736.002.jpg
fig2
The origin of this mass (renal vs. adrenal) was indistinguishable on MRI image due to large tumor burden (Figure 2).
(a) Necrotic mass involving the adrenal gland and perinephric soft tissue. (b) Malignant angiomyolipoma with large tumor cells with abundant eosinophilic cytoplasm. (c) Melan-A/Mart-1 immunohistochemical stain positive within the tumors cells.
CRIM2020-5131736.003.jpg
PMC7103033_01_CRIM2020-5131736.003.jpg
fig3
Subsequently, the patient underwent total right adrenalectomy with en bloc right nephrectomy and resection of regional lymph nodes (Figure 3(a)). These cells are arranged in variably sized nodules with fibrous septae, prominent alveolar growth pattern, with admixed chronic inflammation and extensive necrosis (Figure 3(b)). Immunohistochemistry showed expression of Melan-A/MART-1 (Figure 3(c)), synaptophysin, HMB-45, and CD10 (focal) by tumor cells, but negative expression of PAX8, CK7, smooth muscle actin, inhibin, chromogranin, calretinin, SOX10, and S100.