case_images: PMC10565028_01
case_images: (A) Heterogeneous echogenic mass with a size of approximately 72 x 57 mm in the left adrenal gland with clear boundary and regular shape, in which patchy anechoic areas were observed. (B) No significant blood flow signal inside the left adrenal mass.
case_images: fcvm-10-1236896-g001.jpg
case_images: PMC10565028_01_fcvm-10-1236896-g001.jpg
case_images: F1
case_images: Echocardiography showed normal findings, and abdominal ultrasonography revealed a mass in the left adrenal region (72 x 57 mm, Figure 1).
case_images: (A) Ct scan showing a soft tissue mass in the left adrenal gland with uneven internal density, clear borders, and regular shape. (B) White arrows point to the left adrenal mass in the arterial phase, which is significantly enhanced and necrotic inside. Red arrows point to dissection of the abdominal aorta.
case_images: fcvm-10-1236896-g002.jpg
case_images: PMC10565028_01_fcvm-10-1236896-g002.jpg
case_images: F2
case_images: A soft tissue mass was observed in the left adrenal gland, with uneven density, approximately 61 x 53 mm in size, with a clear boundary, and with significant enhancement after contrast-enhanced scanning in which there was necrosis; pheochromocytoma was first considered (Figure 2).
case_images: CTA showing medial migration of the intimal sheet from the descending thoracic aorta to the level of both common iliac arteries, and the lumen showing "double-lumen" changes, consistent with aortic dissecting aneurysms (Stanford type B). (A) Maximal intensity projection of the sagittal section of the aorta. (B) Three-dimensional reconstruction of the aorta.
case_images: fcvm-10-1236896-g003.jpg
case_images: PMC10565028_01_fcvm-10-1236896-g003.jpg
case_images: F3
case_images: The patient subsequently underwent aortic computed tomographic angiography (CTA), which revealed Stanford TBAD (Figure 3).
case_images: (A) Hematoxylin-eosin staining (HE) showing that the tumor cells were distributed in nests and beams, and thin-walled and reticular blood vessels were abundant between the cell nests (10 x 10). (B) Hematoxylin-eosin staining (HE) showing that the tumor cells were round or oval at high magnification, finely stained, granular, and evenly distributed, with no mitotic figures observed (10 x 20). (C) Immunohistochemical staining showing chromogranin A (CgA) (+). (D) Immunohistochemical staining showing synaptophysin (Syn) (+).
case_images: fcvm-10-1236896-g004.jpg
case_images: PMC10565028_01_fcvm-10-1236896-g004.jpg
case_images: F4
case_images: Immunohistochemical staining showed chromogranin A (CgA) (+), S-100 protein (S-100) (+), synaptophysin (Syn) (+), CD56 (+), epithelial membrane antigen (EMA) (-), vimentin (+), GFAP (-), and Ki-67 (+5%) (Figure 4).