case_images: PMC9261228_01
case_images: Contrast-enhanced computed tomography (CT), venous phase, axial view
case_images: 43159_2022_189_Fig1_HTML.jpg
case_images: PMC9261228_01_43159_2022_189_Fig1_HTML.jpg
case_images: Fig1
case_images: A T2-weighted, coronal view. B T2-weighted, axial view. C Fat suppressed sequence, axial view. D Gadolinium enhanced T1, axial view. The formation shows strongly heterogeneous MR-characteristic, mainly cystic (T2-hyperintense) and with hemorrhagic content (T1-hyperintense); there is presence of a relatively thick capsule (possibly a pseudocapsule due to a highly thin and peripherally dislocated parenchyma) and fine septa. After application of contrast material, there is an amplification of the signal at the periphery (capsule/pseudocapsule) of the lesion and in the septa. Mass effect on the upper pole of the right kidney, right hepatic lobe, inferior vena cava, and right renal vein is present
case_images: 43159_2022_189_Fig2_HTML.jpg
case_images: PMC9261228_01_43159_2022_189_Fig2_HTML.jpg
case_images: Fig2
case_images: Abdominal ultrasound and magnetic resonance imaging (MRI) were performed and demonstrated decrease of the cyst dimensions to 52 x 50 mm (Fig. 2).
case_images: Intraoperative view of the cystic lesion; RK:right kidney; IVC:inferior vena cava; Tu:tumor; RRV:right renal vein
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case_images: PMC9261228_01_43159_2022_189_Fig3_HTML.jpg
case_images: Fig3
case_images: Despite the initial plan to perform cystectomy, the intimate adhesion of the lesion to the adrenal gland and vena cava inferior necessitated en-bloc adrenalectomy to prevent spillage of the cyst content (Fig. 3).
case_images: Macroscopic appearance:shining surface, intact adrenal gland:above; Adr:adrenal gland; Tu:tumor
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case_images: PMC9261228_01_43159_2022_189_Fig4_HTML.jpg
case_images: Fig4
case_images: The tumor appeared black-brown with a shining surface due to its cellular pigmentation (Fig. 4).
case_images: A Tumor formation (black arrow) without connection to the adrenal gland (blue arrow), hematoxylin and eosin stain, original magnification 14x. B Large field of necrosis (arrow) in the central area of the tumor, hematoxylin and eosin stain, original magnification 20x. C Psammoma body calcium aggregates (arrows) within the tumor parenchyma, hematoxylin and eosin stain, original magnification 80x. D Hypercellular tumor parenchyma with multiple pigmented Schwan cells, hematoxylin and eosin stain, original magnification 200x
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case_images: PMC9261228_01_43159_2022_189_Fig5_HTML.jpg
case_images: Fig5
case_images: The adrenal gland was intact with no tumor infiltration (Fig. 5).
case_images: A Multiple mitotic figures (arrows), hematoxylin and eosin stain, original magnification 400x. B Strong immunopositivity for anti-HMB45, original magnification 100x. C Strong immunopositivity for anti-Melan A, original magnification 100x. D Strong immunopositivity for anti-S100, original magnification 100x
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case_images: PMC9261228_01_43159_2022_189_Fig6_HTML.jpg
case_images: Fig6
case_images: Individual cells expressed inhibin alpha, Chromogranin A and Ki 67 to about 10 to 15% (Fig. 6).