MEETING No 47 HELD ON NOVEMBER 13th, 2002 AT THE SAN RAFFAELE HOSPITAL - MILAN

Case 1
Case 2
Case 3
Case 4
Case 5
Case 6

Case 3


"ADRENAL MASS"
G.L. TACCAGNI – San Raffaele Hospital - Milano
(pict. by dr. Taccagni)

Clinical history: in a 48y.o. woman a routine examination discovers a 14cm adrenal lesion, which consists of tan, soft tissue with numerous 2 to 6 cm, cystic formations, which contain hemorrhagic and /or mucinous, yellowish material.
Microscopic description: the neoplasm consists of nodules and cords of loose, epithelioid cells (pict. 1), sometimes forming solid structures with micro-cysts (pict. 2) admixed to partly loose and partly dense stroma (pict. 3).
The proliferating cells are large, polygonal focally with nuclei with dense, regressive-like chromatin and with large cytoplasm (pict. 4); in the areas where the tumor joins the stroma the cells become spindled (pict. 5).
The cytoplasm is from weakly to strongly eosinophilic, finely granular and with indistinct borders (pict. 6).
There is also a smaller, more immature component, which shows nevertheless the same cytological features (pict. 7).
Some isolated cells are larger, with the entire cytoplasm occupied by cytoplasmic granules (ossifile mitochondria with EM) and by lipid droplets and with markedly regressive nuclei, pushed to a cellular pole (pict. 8).
The spindled cells tend to loose the cytoplasmic granularity (pict. 9).
With immunocytochemical staining the neoplastic cells are positive for Vimentin, negative for Cytokeratins, Chromogranin A, Synaptophysin, NSE, EMA, CEA and CD10; the proliferation index (Mib-1) is inferior to 1%.

Diagnosis

pict. 1	pict. 2
pict. 3	pict. 4
pict. 5	pict. 6
pict. 7	pict. 8
pict. 9

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