case_images: PMC10601808_01
case_images: Axial (a) and coronal (b) contrast-enhanced CT scans upon diagnosis. There is a large, heterogeneous, predominantly soft tissue mass replacing the right adrenal and displacing the kidney and liver. The mass (blue arrows) is well-marginated with no obvious infiltration into surrounding tissues and no intra-venous extension. A few intratumoral streak-like linear densities are from neovascularity. Axial post-contrast T1-weighted MR image (c) depicts the heterogeneous nature of the well-marginated right adrenal tumor (blue arrow).
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case_images: F1
case_images: It was highly vascularized, with a large number of collaterals and focal areas of high enhancement (Fig. 1a-b). Magnetic resonance imaging confirmed a solid heterogeneous enhancing mass which was well marginated, concerning for adrenocortical carcinoma (Fig. 1c).
case_images: Pathological findings of the primary tumor specimen. a Gross tumor demonstrating predominantly yellow color with areas of hemorrhage and necrosis. b-c Light microscopy of the tumor showing adrenal cortical carcinoma with necrosis x20 (b) and mitosis (c).
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case_images: F2
case_images: On gross examination, the tumor was 18 cm in greatest dimension, predominantly yellow in color, and circumscribed with prominent areas of hemorrhage and necrosis (Fig. 2a).
case_images: Axial CT scan 18 months after surgery revealing a growing perinephric nodule (blue arrow) consistent with recurrent/locally metastatic disease (the inferior tip of the right hepatic lobe is seen lateral to the right kidney).
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case_images: F3
case_images: A previous 0.9 cm mass (diagnosed 1 year prior) central from the inferior right hepatic lobe posterior to right kidney grew to 1.4 cm, concerning for local recurrence (Fig. 3).