PMC4772903_01
CT scan showing bilateral adrenal masses (asterisks) with associated tumor thrombus in the renal veins and inferior vena cava (arrowheads). Arrow denotes benign appearing simple cyst in left kidney
nihms761681f1.jpg
PMC4772903_01_nihms761681f1.jpg
F1
Computed tomography scan of the abdomen and pelvis revealed bilateral adrenal masses (19.5-cm tumor in left adrenal and 10.7-cm tumor in right), each associated with tumor thrombus extending from the renal vein into the inferior vena cava (Fig. 1).
Tumor histology and immunohistochemistry a. Carcinoma from the left adrenal is composed of cells with eosinophilic cytoplasm, large nuclei, and prominent nuclei. Papillary architecture is shown at bottom, while cells at the top of the microscopic field have more abundant cytoplasm and some intracytoplasmic hyaline inclusions (arrow) b. Carcinoma from the liver metastasis has prominent papillary architecture and similar cytologic features; admixed neutrophils are present c. Carcinoma from the right adrenal is again similar, but there are scattered very large cytoplasmic hyaline inclusions in this tumor focus d. PAX8 immunohistochemical staining positive in tumor cells e. Racemase (AMACR, P504S) strongly diffusely positive in tumor cells f. Immunostaining for the von Hippel-Lindau protein essentially negative; there was only weak cell membrane, or apical staining focally within the carcinoma, as shown in the top of the panel. The expected normal staining pattern diffuses cytoplasmic and membrane staining (not shown). g. RCC monoclonal antibody staining positive with the expected apical membrane accentuation. h. SF-1 immunohistochemistry negative. Original magnifications: 200x
nihms761681f2.jpg
PMC4772903_01_nihms761681f2.jpg
F2
The architecture was variable, including sheet-like areas, large glands, and papillary architecture (Fig. 2).