PMC10209802_01
Bilateral adrenal masses on abdominal CT - An abdominal CT image showing the bilateral adrenal masses with thickened irregular capsules, irregular margins, and nodular surface concerning for adenoma vs metastatic disease.
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Adrenal glands had thickened irregular capsule, irregular margins, and nodular surface concerning for adenoma versus metastatic disease (Fig. 1).
Endoscopic ultrasound image of left adrenal mass - An endoscopic ultrasound image showing the 4.2 x 3.2 mm left adrenal mass.
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The mass was predominantly solid with a few small non-echoic necrotic and hyperechoic areas (Fig. 2, Fig. 3) with well-defined borders and an intact interface was seen between the mass and adjacent structures suggesting a lack of invasion.
PAS stain - Cell block section containing clusters of yeasts (size 2-4 microm) showing narrow-based budding (arrow) compatible with Histoplasma species (GMS stain X600).
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Fungal staining (PAS) revealed narrow-based budding compatible with Histoplasma on Grocott's Methenamine Silver stain (Fig. 4).