case_images: PMC10523022_01
case_images: CT scan (A) and MRI scan (B) images presenting an irregular shaped mass in the gallbladder fossa, and multiple intrahepatic nodular lesions. Pituitary MRI (C) showing a Rathke cyst in the posterior pituitary gland with high signal intensity on T2WI. Bilaterally enlarged adrenal glands are displayed (D).
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case_images: PMC10523022_01_fendo-14-1224381-g001.jpg
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case_images: MRI ( Figure 1B ) scans consistently detected a mass in the gallbladder invading the liver. Multiple metastases were discovered in the liver. The pituitary gland appeared normal except for a Rathke cyst ( Figure 1C ). ACTH, was also noted ( Figure 1D ). A CT-guided transdermal biopsy of liver metastasis was successfully performed.
case_images: Histological and immunohistochemical examination of liver metastasis. (A) Tumor cells gather into nests or sheets and infiltrate the fibrous stroma (H&E stain, x100). (B) Cellularity is very high with hyperchromatic nuclei and no discernible nucleoli is observed (x200). (C) Immunohistochemical staining of Ki 67. Tumor cells demonstrate a Ki 67 index of 67%. (D) Tumor cells demonstrate positive expression of chromogranin A. (E) Positive expression of synaptophysin is observed in tumor cells. (F) ACTH is diffusively expressed in the cytoplasm of tumor cells.
case_images: fendo-14-1224381-g002.jpg
case_images: PMC10523022_01_fendo-14-1224381-g002.jpg
case_images: f2
case_images: Immunohistochemical analysis revealed a small cell neuroendocrine tumor with positive staining of chromogranin A, synaptophysin, and ACTH ( Figure 2 ).