PMC6815537_01
(a) Initial CT scan which shows 2.8 cm right suprarenal hypodense mass, extending to the spinal canal (T9-T12) and cause spinal cord compression (yellow arrow). (b) Histology of the tumor is composed of large pleomorphic cells with prominent nucleoli and clear nearly vacuolated cytoplasm (inset); background of scattered acute inflammatory cells are seen (Hematoxylin and eosin (H&E) stain; 40x). (c) Tumor cells containing more abundant eosinophilic cytoplasm, with focal myxoid changes (inset) (Hematoxylin and eosin (H&E) stain; 10x). (d) Tumor cells are diffusely positive for SMA (20x). (e) Focal tumor reactivity for EMA is seen (20x). (f) Complete loss of tumor cells' immunoreactivity for SMARCB1/INI1, with maintained internal control in lymphocytes between tumor cells (red arrow) (20x).
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Arabia, in July 2015 with a ten-day history of back pain and progressive weakness of the lower extremities and an inability to walk. A computerized tomography (CT) scan performed at that time revealed a right suprarenal hypodense mass measuring 2.8 x 3 x 4.6 cm and extending to the spinal canal (T9-T12) to cause spinal cord compression (Figure 1(a)). Some of the cells had clear, nearly vacuolated cytoplasm (Figure 1(b)), and scattered cells contained more abundant, eosinophilic cytoplasm, but there were no classic rhabdoid cells with accumulation of intermediate filaments (Figure 1(c)). Immunohistochemistry for antibodies targeting vimentin, smooth muscle actin alpha (SMA) (Figure 1(d)), and p63 was positive, and there was focal positivity for Bcl-2 and focal weak positivity for CD99, CD10, CK8/18, calponin, and epithelial membrane antigen (EMA) (Figure 1(e)). However, there was loss of tumor cell immunoreactivity for SMARCB1/INI1 (Figure 1(f)), and Ki-67 was positive in >50% of tumor cells.