case_images: PMC10601835_01
case_images: Axial computed tomography images without (left) and with (right) contrast, with extravasation of contrast causing hematoma.
case_images: cro-2023-0016-0001-534129_F01.jpg
case_images: PMC10601835_01_cro-2023-0016-0001-534129_F01.jpg
case_images: F1
case_images: As her vital signs stabilized after transfusion with two packs of erythrocytes, computed tomography (CT) of the abdomen and pelvis (Fig. 1) was performed, revealing loss of morphology of the right adrenal gland due to an ovoid lesion measuring 11.4 x 10.2 x 10.3 cm.
case_images: Green and yellow arrows: extravasation of contrast medium in the distal portion of the right inferior adrenal artery. Purple and blue arrows: angiography and embolization of the right inferior adrenal artery.
case_images: cro-2023-0016-0001-534129_F02.jpg
case_images: PMC10601835_01_cro-2023-0016-0001-534129_F02.jpg
case_images: F2
case_images: Due to the origin of the bleeding, instead of performing laparotomy, it was decided to perform interventional radiology with angiography of the right renal artery, angiography and embolization of the right inferior adrenal artery, and angiography of the right upper and middle adrenal arteries, resulting in the discovery of bleeding from the right inferior adrenal artery and an anatomical variant of the superior polar renal artery (Fig. 2).
case_images: Tumor encapsulated in the right adrenal gland with a decrease in size.
case_images: cro-2023-0016-0001-534129_F03.jpg
case_images: PMC10601835_01_cro-2023-0016-0001-534129_F03.jpg
case_images: F3
case_images: The tumor still caused anterior displacement of segment V toward the medial anterior to the inferior vena cava and caudal displacement of the right kidney through its upper pole (Fig. 3).
case_images: a, b Macroscopic view of the tumor. a Outer surface. b Cut surface. c Low-power view of the tumor showing randomly arranged bundles of plump spindle cells. d Smooth muscle actin positivity.
case_images: cro-2023-0016-0001-534129_F04.jpg
case_images: PMC10601835_01_cro-2023-0016-0001-534129_F04.jpg
case_images: F4
case_images: On macroscopic examination, the tumor measured 10 cm at its maximum diameter, weighed 109 g, was soft and depressible, oval in shape, with a dull surface, and heterogeneous in color with some dark brown and light gray areas (Fig. 4a, b). Microscopic examination revealed a neoplasm composed of bundles of randomly arranged plump spindle cells (Fig. 4c). On immunohistochemical examination, tumor cells were positive for anti-actin specific muscle (AAME) and anti-actin smooth muscle (AAML) and were negative for anaplastic lymphoma kinase-1 (Fig. 4d).