case_images: PMC4293550_01
case_images: Adrenal computed tomography findings. (A) The mass located at the lateral rim of the adrenal gland was 2.8 cm and its attenuation value was 27.7 Hounsfield unit (HU) initially, 158.5 HU at 1 minute, and 69.8 HU at 15 minutes. (B) The other mass measured 1.4 cm and was located at the medial rim of the adrenal gland. Its attenuation value was 42.67 HU initially, 87 HU at 1 minute, and 57.2 HU at 15 minutes (arrows).
case_images: kjim-30-114-g001.jpg
case_images: PMC4293550_01_kjim-30-114-g001.jpg
case_images: F1
case_images: CT of the adrenal glands showed two enhancing nodular lesions in the right adrenal gland that demonstrated rapid washout of contrast media consistent with cortical adenomas (Fig. 1).
case_images: Fresh right adrenalectomy surgical specimen, measuring 6.5 x 4.3 x 2.3 cm and weighing 22 g. The cut section shows two well-defined masses. Pathologically, the larger mass was diagnosed as an adrenal cortical adenoma and the smaller as a pheochromocytoma. (A) The larger mass measures 2.7 x 2.5 x 1.9 cm and is yellow and brown with hemorrhage (arrows). (B) The other mass is 0.7 x 0.7 cm, rubbery, and yellow-white (arrow). (C) Microscopic pathology findings of the right adrenal gland showed a typical adrenal cortical adenoma. The cells are larger, have different cytoplasm, and increased variation in nuclear size compared to a normal adrenal gland (H&E, x40). (D) The cells have finely granular basophilic cytoplasm, intracytoplasmic hyaline globules, and round and oval nuclei with a prominent nucleolus and variable inclusion-like structures compatible with pheochromocytoma (H&E, x40). (E) The immunohistochemical staining was positive for chromogranin A (x200).
case_images: kjim-30-114-g002.jpg
case_images: PMC4293550_01_kjim-30-114-g002.jpg
case_images: F2
case_images: The larger one, measuring 2.7 x 2.5 x 1.9 cm, was yellow and brown-tan with hemorrhage (Fig. 2A). The other, measuring 0.7 x 0.7 cm, was rubbery and yellow-white (Fig. 2B). After discharge, the pathology report revealed two solid, well-encapsulated tumors with negative resection margins measuring 2.7 x 2.5 x 1.9 cm (Fig. 2A) and 1.0 x 1.0 cm (Fig. 2B). Microscopy and immunohistochemistry confirmed that the larger mass was a cortical adenoma that likely caused the Cushing syndrome (Fig. 2C), while the smaller mass was a pheochromocytoma (Fig. 2D). The immunohistochemical staining for chromogranin A was positive (x200) (Fig. 2E).