case_images: PMC11148276_01
case_images: Imaging changes in PCC: In July 2021, the arrows pointed to the adrenal mass on abdominal and enhanced CT scans (A, B). In December 2021, no abnormalities were seen in abdominal CT scans (C). In November 2022, the arrows pointed to lung and bone metastasis on PET-CT (D). In March 2023, the arrows indicated liver metastases on liver MR images (E, F). In May 2023, the arrows pointed to spine metastases on MR images (G). In July 2023, the arrows indicated liver metastases on liver MR images (H, I). In September 2023, CT scan showed extensive lung metastases with inflammation (J, K).
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case_images: Adrenal enhancement computed tomography (CT) revealed a space occupying lesion in the right adrenal region (about 4.2x5.9cm in size) (Figures 1A, B) and normal lung CT. 18F-fuorodeoxyglucose positron emission tomography (PET)/CT revealed a mass in the right adrenal region with unevenly increased glucose metabolism (maximum cross-sectional area of 5.68x4.81 cm). The adrenal CT was normal 5 months after operation (Figure 1C). Additionally, heightened glucose metabolism was observed in the sternum, cervical 2, thoracic 4, 5, 7, 8, lumbar 3-5 vertebral bodies, left iliac bone, and right femur (Figure 1D). The imaging changes of metastatic lesions in March and May 2023 are shown in Figures 1E-G. By July 2023, the patient began experiencing significant dyspnea and intermittent hemoptysis, indicating rapid disease progression (Figures 1H, I). Metastatic lesions in the liver and lungs had increased (Figures 1J, K), along with elevated levels of NMN, NE, and NSE(Supplementary Table 1).
case_images: Pathology of PCC after surgery and metastasis:A-D showed pathology images of PCC after surgery. The gross specimen was a right retroperitoneal adrenal mass with incomplete capsule (A). HE staining revealed small nests of chief cells with small and interspersed blood vessels(x 400) (B). Tumor cells demonstrated diffuse CgA positivity (x 400) (C) and SyN positivity(x400) (D). (E-H) displayed pathology images of lung metastases. Lung metastatic cells were negative for CK (x 400) (E). The HE staining showed similar characteristics to the primary tumor (x 400) (F). The lung metastatic cells exhibited diffuse CgA positivity (x 400) (G) and SyN positive (x 400) (H).
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case_images: Immunohistochemical (IHC) staining indicated positivity for chromogranin A (CgA), synaptophysin (SyN), Ki-67 (5%+), succinate dehydrogenase B (SDHB), NSE, and sustentacular cells (individual cells+) (Figures 2A-D). The lung and bone lesions showed positive results for CgA, SyN, SDHB, vimentin (VIM), CD56, GATA3, and somatostatin receptor 2 (SSTR 2), with Ki-67 levels at 30% in the lung and 5% in the bone, indicating metastatic PCC (Figures 2E-H).