Man in his 50s with periodic sweating and diarrhea
Abdul M Abid M.D. and Robert Peel M.D.
History
A 50 year old male patient presented with periodic sweating, diarrhea, redness and feeling of heart racing. He has a family history of Van Hippel Lindau disease. On imaging, a mass in the right adrenal gland is discovered, which was resected. Photomicrographs are provided
Images 1-3
Synaptophysin, Chromogranin, HMB-45
Microscopic description
(Images 1-3)
Histologic sections show an infiltrative mass, with an alveolar pattern, with cells arranged in small nests (Zellballen) of neuroendocrine cells with interspersed small blood vessels. Tumor cells are larger than normal chromaffin cells, with large nucleoli. Extreme pleomorphism and hyperchromasia is seen. Rare mitotic figures are present. There is a melanin-like pigment seen as well.
(Synaptophysin, Chromogranin, HMB-45)
On immunohistochemistry, Synaptophysin and Chromogranin are positive while HMB45 is negative. This immunoprofile is consistent with a pheochromocytoma.