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Arising from the anterior limb of the left adrenal gland is a 3-4 cm rounded mass with peripheral enhancement. It sits anterior to the left kidney which appears normal. The right adrenal gland is normal.
The patient went on to have laparoscopic adrenalectomy.
The majority of the tumour is surrounded by a fibrous capsule, which is very attenuated in areas but tumour does not appear to extend to the inked external surface. The tumour shows moderate cytologic atypia with very scant mitotic activity. The tumour shows focal sustentacular pattern of S100 positivity. It is also positive for synaptophysin and neuron specific enolase.
Final Diagnosis: pheochromocytoma
- Pheochromocytoma, measuring 3 cm in maximum dimension.
- No definite evidence of lymphovascular invasion.
Please note that there is no reliable histological criteria for distinguishing benign versus malignant pheochromocytoma.