PMC4382977_01
Images of computed tomography (a) and corresponding positron emission tomography (b) scan of the patient's abdomen showing the adrenal mass (arrow), 1.5 cm in diameter and standardized uptake value of 9.8
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F1
The adrenal mass was suspicious for metastasis [Figure 1].
Low magnification of fine-needle aspiration smears, showing loosely cohesive sheets and single cells of oncocytic pheochromocytoma with Diff-Quik (a) and Papanicolaou (b) stains, (x100)
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F2
Evaluation of the aspirate smears and cell block preparations showed numerous loosely cohesive sheets and singly scattered tumor cells with abundant eosinophilic granular cytoplasm [Figures 2-4]. These cells exhibited marked nuclear pleomorphism, indistinct cell borders, and occasional intranuclear pseudoinclusions [Figures 2-4].
High magnification of tumor cells showing markedly pleomorphic and bizarre nuclei. (a) and (c) show binucleation and (b) and (d) show intranuclear pseudoinclusions, (x600)
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F3
Evaluation of the aspirate smears and cell block preparations showed numerous loosely cohesive sheets and singly scattered tumor cells with abundant eosinophilic granular cytoplasm [Figures 2-4]. These cells exhibited marked nuclear pleomorphism, indistinct cell borders, and occasional intranuclear pseudoinclusions [Figures 2-4]. Occasional binucleated cells and cells with bizarre nuclei were also identified [Figure 3].
(a and b) Cell block preparation of the aspirate stained with H and E showing oncocytic tumor cells with abundant eosinophilic granular cytoplasm, nuclear pleomorphism, cytoplasmic inclusions (arrowhead), and intranuclear pseudoinclusions (arrows). Tumor cells show strong positivity to chromogranin (c) and synaptophysin (d), (x400)
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F4
Evaluation of the aspirate smears and cell block preparations showed numerous loosely cohesive sheets and singly scattered tumor cells with abundant eosinophilic granular cytoplasm [Figures 2-4]. These cells exhibited marked nuclear pleomorphism, indistinct cell borders, and occasional intranuclear pseudoinclusions [Figures 2-4]. The tumor cells were positive for neuroendocrine markers, CD56, chromogranin [Figure 4c], and synaptophysin [Figure 4d], consistent with the diagnosis of pheochromocytoma.