case_images: PMC5786566_01
case_images: (A). Axial image on portal phase computed tomography (CT) scan showing right adrenal mass heterogeneously enhanced of 7.6 cm x 5.8 cm. (B). Cross-sectional image on CT scan showing right adrenal mass with imprint on the liver. (C). Maximum intensity projection image on FDG positron emission tomography showing the two hypermetabolic masses, right adrenal, and right thyroid lobe.
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case_images: PMC5786566_01_fendo-08-00384-g001.jpg
case_images: F1
case_images: Abdominal ultrasound (US) revealed a hypoechoic mass, and CT scan revealed a 7.6 cm x 5.6 cm x 7.4 cm right adrenal mass, hyperdense (>50 Hounsfield units) with delayed wash out after contrast injection (Figures 1A,B). Because of suspected malignancy, a 18F-FDG PET was performed, revealing a highly metabolic 7.3 cm x 5.6 cm x 8.1 cm right adrenal mass (SUVmax 88.7) with a mass effect on the liver (Figures 1A-C and 2A).
case_images: (A) Cross-sectional image on FDG positron emission tomography (PET) showing right adrenal mass at SUV max 88.7. (B) Cross-sectional image on FDG PET showing right thyroid mass at SUV max 10.6.
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case_images: PMC5786566_01_fendo-08-00384-g002.jpg
case_images: F2
case_images: Because of suspected malignancy, a 18F-FDG PET was performed, revealing a highly metabolic 7.3 cm x 5.6 cm x 8.1 cm right adrenal mass (SUVmax 88.7) with a mass effect on the liver (Figures 1A-C and 2A). In addition, a hypermetabolic right thyroid lesion of 1.2 cm was found (SUVmax 10.6; Figure 2B) without suspicious lymph nodes, and US-guided FNA revealed PTC.
case_images: Macroscopically, the adrenal tumor was a rounded, well-circumscribed orange brown homogeneous mass, measuring 8.5 cm x 6 cm x 4.5 cm (A). The size of the grid in the background is 1 cm x 1 cm. Microscopically, it was well circumscribed and partially encapsulated and consisted entirely of bland looking oncocytic cells, with granular eosinophilic cytoplasm and round nuclei with prominent nucleoli, arranged in a solid pattern (B,C). Parenchymatous or venous invasion, high mitotic rate, and atypical mitoses were not observed. Therefore, according to the Lin-Weiss-Bisceglia criteria, it was diagnosed as a benign oncocytic adrenocortical adenoma. Further evaluation using immunohistochemistry revealed negative BRAF V600E immunostaining and a low Ki-67 proliferation index (<2%) (D).
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case_images: PMC5786566_01_fendo-08-00384-g003.jpg
case_images: F3
case_images: Histopathology of the adrenal showed a rounded, well-circumscribed, and encapsulated mass, measuring 8.5 cm, without necrosis (Figure 3A). Microscopically, the tumor was entirely composed of oncocytic cells (Figures 3B,C). Further evaluation using immunohistochemistry revealed negative BRAFV600E immunostaining and a low Ki-67 proliferation index (<2%) (Figure 3D).
case_images: Macroscopically, the thyroid tumor was a rounded, well-circumscribed white intrathyroidal nodule measuring 1.2 cm x 1 cm x 0.8 cm (A). The size of the grid in the background is 1 cm x 1 cm. Microscopically, the tumor consisted of cuboidal cells arranged mostly in follicles with a few papillae, showing classical nuclear features of papillary thyroid cancer (PTC), including chromatin pallor, numerous nuclear grooves, and several nuclear pseudoinclusions (B,C). Further evaluation using immunohistochemistry revealed positive BRAF V600E immunostaining in the tumor cells (D), consistent with the classical type of PTC (BRAF-like PTC).
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case_images: PMC5786566_01_fendo-08-00384-g004.jpg
case_images: F4
case_images: Histopathology of the thyroid gland revealed an invasive PTC of 1.2 cm, BRAFV600E positive, without lymphovascular invasion (Figures 4A-D), staged pT1b, N1a, R1 (3/4 positive central lymph nodes, R1: microscopically positive resection margin).