Presentation
The patient, with a previous history of right adrenalectomy for myelolipoma, presented with abdominal distension.
Patient Data
A large, sharply demarcated, heterogeneously enhancing lobulated mass is noted in the right suprarenal region, with internal areas of necrosis.
There is no evidence of internal calcifications.
The mass is inseparable from the adjacent liver parenchyma, suggesting possible invasion.
It is surrounded by fat stranding and is associated with multiple pathologically enlarged retroperitoneal lymph nodes.
The mass appears to invade the right hemidiaphragm and extends into the right lower lung lobe.
An incidental calcified liver granuloma is noted.
Case Discussion
The patient underwent a lung biopsy, and histopathological examination revealed lung tissue infiltrated by metastatic carcinoma with clear cell features, positive for CAIX but negative for PAX8. Immunohistochemical markers for adrenal tumours, including SF1, Synaptophysin, and Inhibin, were positive. These findings are consistent with metastatic carcinoma of adrenal cortical origin despite the previous right adrenalectomy for a large myelolipoma.
The tumour is non-functioning, and the patient has been referred to an oncology surgeon for further management.
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