case_images: PMC7085350_01
case_images: Contrast-enhanced CT abdomen, chest, and pelvis: (a) coronal image and (b) axial image showing heterogeneously enhancing left suprarenal mass (21 x 18 x 24 cm)* with central necrosis and foci of calcifications. Focal liver metastasis** is also seen.
case_images: CRIE2020-2025631.001.jpg
case_images: PMC7085350_01_CRIE2020-2025631.001.jpg
case_images: fig1
case_images: There were multiple liver, lymph node, and pulmonary metastasis to note (Figure 1).
case_images: CECT chest and abdomen (axial image): large liver metastasis* (largest: 12 x 11 cm in segment VII and VIII) and lung metastases**.
case_images: CRIE2020-2025631.002.jpg
case_images: PMC7085350_01_CRIE2020-2025631.002.jpg
case_images: fig2
case_images: Moreover, CECT chest, abdomen, and pelvis showed recurrence of the previously detected tumor (42  mm x 37  mm, 85 x 68 mm and 73 x 86 mm size tumor masses intra-abdominally) with multiple liver (largest of the metastases being 12 x 11 cm in size in segment VII and VIII), renal (40 x 62 mm), and lung metastases (Figure 2).
case_images: H&E stain (high power): solid sheets and nests of tumor cells, containing pleomorphic vesicular nuclei with coarse chromatin and eosinophilic cytoplasm.
case_images: CRIE2020-2025631.003.jpg
case_images: PMC7085350_01_CRIE2020-2025631.003.jpg
case_images: fig3
case_images: Histology (Figure 3) showed an encapsulated multinodular tumor composed of solid sheets and nests of tumor cells with thick fibrous bands separating them, containing pleomorphic vesicular nuclei with coarse chromatin and eosinophilic cytoplasm.
case_images: Immunohistochemical staining: (a) synaptophysin stain (patchy positivity), (b) inhibin stain (focal cytoplasmic positivity), (c) Chromogranin stain (negative), and (d) Pan CK stain (negative).
case_images: CRIE2020-2025631.004.jpg
case_images: PMC7085350_01_CRIE2020-2025631.004.jpg
case_images: fig4
case_images: The IHC staining profile (Figure 4) showed patchy positivity for synaptophysin and focal cytoplasmic positivity for inhibin.
case_images: ACTH Immunostaining: few scattered tumor cells showing granular cytoplasmic positivity.
case_images: CRIE2020-2025631.005.jpg
case_images: PMC7085350_01_CRIE2020-2025631.005.jpg
case_images: fig5
case_images: Tumor cells showed granular cytoplasmic positivity for ACTH favoring aberrant ACTH production by ACC cells (Figure 5).