Presentation
Uncontrolled hypertension, mass found on screening renal ultrasound.
Patient Data
CT abdomen and pelvis in four phases demonstrate a large well-defined mass under the left hemidiaphragm that promotes displacement of the left kidney inferiorly and the spleen anteriorly. The tumor has large cystic areas within and heterogeneous contrast enhancement. No surrounding stranding or lymphadenopathies were identified.
MACROSCOPIC DESCRIPTION: mass has a smooth, greenish yellow capsule 1 mm in thickness that
appears complete. Fatty connective tissue lies over the capsule. The tumor is variegated black/brown/yellow and firm. There is a central cavity up to 60 mm in greatest diameter that is filled with reddish/brown friable fibrinous material.
MICROSCOPIC DESCRIPTION: Sections show an encapsulated cellular tumor. The tumor is composed of islands and nests of cells with a delicate interspersed capillary network. The cells are polygonal and have round to oval nuclei with smooth contours, finely stippled chromatin with occasional inconspicuous nuclei, and a large amount of finely granular cytoplasm. Pleomorphism is mild to marked, with scattered areas taking on a spindle cell morphology. Mitoses are rare or absent. Scattered intracytoplasmic and extracellular globular eosinophilic material is seen. Lakes of hemorrhage are seen scattered throughout the lesion but there is no necrosis. The tumor does not breach the capsule. The lesion is completely excised.
DIAGNOSIS: Pheochromocytoma
Case Discussion
The imaging features, in this clinical scenario, are those of a well-defined large pheochromocytoma. The diagnosis was confirmed with the histology of the tumor.
These tumors, as it was in this case, usually present as large masses within the adrenals.