Case 51

 Surgical Pathology Case
 
Clinical Information
  61 year-old male, history of elevation of plasma metanephrines and symptoms of catecholamine excess. Blood: metanephrines 373 (normal <82), normetanephrine 195 (38-175), and total meta 568 (61-246); urine: metanephrines 1177 (90-315), normetanephrine 484  (122-676), total 1661(224-832). CT scan showed enlarged left adrenal gland measuring 2.8 x 2.6 cm with a 1.4 x 1.4 cm low-density center.
Gross Description
 

The specimen consists of a piece of yellow-orange glandular and adipose tissue with attached cystic structure measuring 7.0 x 3.0 x 2.2 cm.   The specimen is inked in black.  Upon sectioning through the specimen reveals a tan/brown mass measuring 2.5 x 1.8 x 2.5 cm in which a central hemorrhagic cystic cavity measuring 1.0 x 0.8 x 0.8 cm. Adjunct to the mass is a yellow/orange parenchyma that is unremarkable.

 
 
     
 
  HE, 2× HE, 4×
 
  HE, 4× HE, 10×
 
  HE, 10× HE, 10×
 
  HE, 20× HE, 20×
 
  HE, 20× HE, 20×
 
  HE, 40× HE, 40×
 
  HE, 40× HE, 40×
 
  HE, 40× HE,40×
 
  HE, 40× HE,40×
 
  HE, 60× HE, 40×
     
 

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Source: Department of Pathology, Creighton University Medical Center, Omaha, NE

Photo: Zenggang Pan

Discussion: Zenggang Pan