Case 77

Surgical Pathology Case
 

CLINICAL INFORMATION

  46 year-old male, had a history of hypertension. For one year, he had episodes of headache that lasted for five minutes with a blood pressure of up to 240/120 during episodes. CT scan showed a 16-18 cm right adrenal mass. Serum and urine metanephrine were in the range of 20,000.

GROSS DESCRIPTION

 

The specimen consists of one encapsulated mass measuring 18.0 x 14.0 x 13.0 cm and weighs 1450 grams. The outer surface is smooth and shiny. No residual adrenal glands are identified. Upon bisection, the specimen reveals multiple cysts and solid areas. The largest cyst measures 11.0 cm and contains dark red fluid. The cyst wall ranges from 0.6 cm to 3.0 cm. The inner surface of the cyst is rough with finely granular pattern, and focal areas have attached yellow-brown soft tissues. The solid area consists of multiple well-demarcated nodules with the largest measuring 3.5 cm in diameter with a yellow and dark brown cut surface. The entire specimen is serially sectioned and fixed overnight. Gross photographs are taken. Portion of the fresh specimen are submitted for cytogenetic studies and electron microscopic studies. Touch imprints and aspirate slides are prepared. After overnight fixation the solid nodules turn out to be bright yellow-brown.

     
 
     
 
     
 
 

 

 

 
 

 

 

 
 

HE, 4

HE, 20

 
 

HE, 40

HE, 40

 
 

HE, 20

HE, 20

 
 

HE, 40

HE, 20

 
 

HE, 40

Cyst Aspirate, Pap staining, 40
 
 

Cyst Aspirate, Wright-Giemsa Staining, 20

Cyst Aspirate, Wright-Giemsa Staining, 20
 
 

Cyst Aspirate, HE, 40

Cyst Aspirate, HE, 40
     
 

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

Photo: Zenggang Pan

Discussion: Zenggang Pan