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- W2138504143 abstract "65-year-old white woman presented to her primary care physician with the complaint of right upper quadrant pain. Her medical history was remarkable for hypertension, diabetes mellitus, and asthma. She was evaluated for cholelithiasis, and gallstones were detected. A 6.0-cm right adrenal mass was detected by computed tomographic scan (Figure 1). Evaluation of the chest, abdomen, and pelvis, including computed tomographic scanning and magnetic resonance imaging revealed no other lesions. Determination of urinary cortisol and vanillylmandelic acid levels showed no evidence of a functioning tumor. Cholecystectomy and excision of the right adrenal mass were performed. The gallbladder showed chronic cholecystitis and cholelithiasis. The right adrenalectomy specimen consisted of an 8.0 3 7.5 3 5.5-cm ovoid mass with a focally hemorrhagic surface. The hemorrhagic oval mass formed nearly 90% of the specimen, was fairly well circumscribed, and was surrounded by a rim of flattened adrenal tissue. Cut section revealed a variegated cut surface (Figure 2). Histopathologic examination revealed ovoid nests, papillary fronds, and solid areas of tumor cells, which on occasion formed vascular channels containing red blood cells. The tumor cells were large, round to oval, and markedly atypical with moderately abundant amphophilic cytoplasm and poorly developed cell borders. The nuclei were vesicular, round to oval, and contained prominent eosinophilic nucleoli. Brisk mitotic activity was present, and atypical mitotic figures were identified. Occasional intracytoplasmic lumina contained red blood cells (Figure 3). The tumor infiltrated residual adrenal cortical tissue in small clusters and as single cells. The capsule of the adrenal capsule appeared intact. Immunohistochemical studies showed strong staining for factor VIII‐related antigen (Figure 4), vimentin, and focal positivity for pancytokeratin. Staining for neuron specific enolase and synaptophysin were not detected. What is your diagnosis?" @default.
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- W2138504143 date "1999-02-01" @default.
- W2138504143 modified "2023-09-25" @default.
- W2138504143 title "Pathologic Quiz Case" @default.
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- W2138504143 doi "https://doi.org/10.5858/1999-123-0157-pqc" @default.
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