case_images: PMC9846587_01
case_images: Chemical shift magnetic resonance imaging (MRI) showing a heterogeneous
  adrenal mass with a diameter of 23 mm. The adrenal mass showed a mottled
  loss of signal intensity from the in-phase (a) to opposed-phase (b) MR
  images.
case_images: 10.1177_11795514221148556-fig1.jpg
case_images: PMC9846587_01_10.1177_11795514221148556-fig1.jpg
case_images: fig1-11795514221148556
case_images: Magnetic resonance imaging (MRI) revealed a heterogeneous left adrenal mass with a diameter of 23 mm (Figure 1). 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy did not indicate increased uptake in the adrenal mass.
case_images: (a) Positional relationship of the adrenocortical adenoma (arrow) and
  micro-pheochromocytoma (arrowhead). Sectional views of (b) the
  adrenocortical adenoma and (c) the micro-pheochromocytoma. (d)
  Hematoxylin-eosin (HE) staining of the adrenocortical adenoma (x200). Clear
  cells and dense cells coexisted. (e) Lipomatous changes were observed in
  some parts of the adenoma (x40). (f) HE staining of the
  micro-pheochromocytoma (x20). (g) HE staining of the micro-pheochromocytoma
  (x200). (h) Chromogranin A expression of the micro-pheochromocytoma (x200).
  (i) Positive reactivity for MIB-1 was found in less than 1% of the
  micro-pheochromocytoma (x400).
case_images: 10.1177_11795514221148556-fig2.jpg
case_images: PMC9846587_01_10.1177_11795514221148556-fig2.jpg
case_images: fig2-11795514221148556
case_images: The final pathology revealed an adrenocortical adenoma measuring 26 x 24 mm, in which clear and dense cells coexisted (Figure 2a, b, and d). Lipomatous changes were observed in some adenoma areas (Figure 2e). In addition to the adrenocortical adenoma, a small nodule, 3 x 2 mm in size, was incidentally found in the ipsilateral adrenal medulla (Figure 2a, c, and f). Chromogranin A-positive atypical medulla cells proliferated and were arranged in the "zellballen" pattern (Figure 2g and h). The Ki67 labeling index was <1% (Figure 2i).
case_images: Immunohistochemical staining of the micro-pheochromocytoma with (a) tyrosine
  hydroxylase (TH), (b) aromatic L-amino acid decarboxylase (AADC), (c)
  dopamine beta-hydroxylase (DBH), and (d) phenylethanolamine N-methyltransferase
  (PNMT) antibodies (x100). The primary antibodies were mouse monoclonal
  antibodies: anti-TH, F-11, sc-25269; anti-DDC, 8E8, sc-293287; and
  anti-PNMT, C-7, sc-393995, from Santa Cruz Biotechnology, Dallas, USA, and
  the anti-DBH goat polyclonal antibody, ab189991, from Abcam plc, Cambridge,
  UK. Dashed lines show boundaries between the normal adrenal medulla (m) and
  micro-pheochromocytoma (p). The letter c indicates the adrenal cortex.
case_images: 10.1177_11795514221148556-fig3.jpg
case_images: PMC9846587_01_10.1177_11795514221148556-fig3.jpg
case_images: fig3-11795514221148556
case_images: Abcam plc, Cambridge, UK), and phenylethanolamine N-methyltransferase (PNMT; C-7, sc-393995, Santa Cruz Biotechnology) were performed. All of these enzymes were detected in the micro-PCC (Figure 3).
case_images: Catecholamine biosynthetic enzyme expression in the normal medulla and
  micro-pheochromocytoma (PCC). Values are shown as percentages of the stained
  area. Panels (a), (b), (c), and (d) correspond to those in Figure 3.
case_images: 10.1177_11795514221148556-fig4.jpg
case_images: PMC9846587_01_10.1177_11795514221148556-fig4.jpg
case_images: fig4-11795514221148556
case_images: The intensity of anti-TH staining was higher in the micro-PCC lesion than in the normal medulla (Figure 4a), whereas the intensity of anti-DBH, AADC, and PNMT staining did not differ significantly between these 2 regions (Figure 4b-d).