case_images: PMC6051277_01
case_images: MRI abdomen with and without contrast. A 3.4 x 4.0 x 4.7 cm mass is seen in the left adrenal gland. The lesion demonstrated heterogeneous T2 hyperintense/T1 isointense to muscle signal. The T1 signal of the lesion was hypointense relative to the contralateral right adrenal gland.
case_images: CRIE2018-3792691.001.jpg
case_images: PMC6051277_01_CRIE2018-3792691.001.jpg
case_images: fig1
case_images: This revealed a 3.4 x 4.0 x 4.7 cm mass in the left adrenal gland which demonstrated heterogenous T2 hyperintense/T1 isointense muscle signal [Figure 1].
case_images: Pathology from left adrenal. H&E (100x). Classic pattern of small nests (zellballen) made up of polygonal neuroendocrine cells (chief cells). The nests are separated by interspersed small blood vessels and sustentacular cells.
case_images: CRIE2018-3792691.002.jpg
case_images: PMC6051277_01_CRIE2018-3792691.002.jpg
case_images: fig2
case_images: This was consistent with a pheochromocytoma [Figures 2-5].
case_images: Pathology from left adrenal. H&E (400x). High power depicts ample and finely granular eosinophilic cytoplasm. The nuclei exhibit typical "salt and pepper" chromatin, characteristic of all neuroendocrine tumors. Nuclei are round to oval and uniform without significant pleomorphism or mitotic activity. Nucleoli are inconspicuous.
case_images: CRIE2018-3792691.003.jpg
case_images: PMC6051277_01_CRIE2018-3792691.003.jpg
case_images: fig3
case_images: This was consistent with a pheochromocytoma [Figures 2-5].
case_images: Pathology from left adrenal. Chromogranin (100x). Cytoplasmic granular staining diffusely positive in tumor cells.
case_images: CRIE2018-3792691.004.jpg
case_images: PMC6051277_01_CRIE2018-3792691.004.jpg
case_images: fig4
case_images: This was consistent with a pheochromocytoma [Figures 2-5].
case_images: Pathology from left adrenal. Synaptophysin (100x). Cytoplasmic granular staining diffusely positive in tumor cells.
case_images: CRIE2018-3792691.005.jpg
case_images: PMC6051277_01_CRIE2018-3792691.005.jpg
case_images: fig5
case_images: This was consistent with a pheochromocytoma [Figures 2-5].