PMC5310178_01
Abdomen CT scan at initial diagnosis. A 20 cm sized mass in the left upper quarter with irregular margin and inhomogeneous appearance.
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ALP, 60 U/L (reference range, up to 300 U/L), among other findings were within normal limits. Abdominal CT indicated an adrenal lesion in the left upper quarter that displaced left kidney, spleen and pancreas [Fig. 1].
The adrenal mass in the abdominal cavity.
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The adrenal mass was identifed [Fig. 2].
H&E A. Four mitosis in this field marked with arrows three in metaphase and one in anaphase. B. Atypical mitosis is seen in the center of the field. C. Tumor necrosis is displayed in this field.
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Many of the cells were large, pleomorphic, some were multinucleated and bizarre with frequent mitoses up to 4/hpf [Fig. 3A] with aberrant forms [Fig. 3B].
Results of the immunohistochemical studies: A - Inhibin marker is positive. B - ChromograninA marker. Some tumor cells stain darkly. C - ChromograninA marker showing a Golji pattern. D - Claretinin marker is positive. E+F - S-100 protein immunostain mark sustenticular cells.
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S-100 protien marker was expressed in many sustenticular cells [Fig. 4A-F].
The patient in 8 months after the surgery.
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He gained 20 kg weigh [Fig. 5], his new BMI was 31.2 kg/m2, none of old symptoms was back, and no new complains were recorded.
Chest and abdomen CT scan 8 months after left ardrenalectomy and splenectomy. There was no specific changes, and no evidence of metastasis.
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A chest and Abdomen CT appeared no specific changes, and no evidence of metastasis [Fig. 6].
Screening CT scan 18 months after the surgery. Two irregular masses: one posterior the stomach (5.5 x 8 cm2), the other in the right lobe of the liver (16 x 17 cm2).
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Screening CT showed two irregular masses: one was (5.5 x 8 cm2) posterior to the stomach, the other was (16 x 17 cm2) in the right lobe of the liver [Fig. 7].