Fine Needle Aspiration of 81 Year-Old Female with an Adrenal Mass

by Brent J. Huddleston, MD Fellow, Cytopathology. University of Utah, Department of Pathology

Editor: Brian T. Collins, MD, Professor of Pathology, University of Utah, and Medical Director, Cytopathology, ARUP Laboratories

An 81-year-old female residing in a skilled nursing facility has a past medical history significant for hypertension, diabetes mellitus, hypothyroidism, hyperlipidemia, and coronary artery disease. The patient complains of an approximately 5-month history of weakness, fatigue, decreased oral intake, 20-pound weight loss, night sweats, nausea, vomiting, and occasional syncope. These have all been getting worse over time. The syncope occurs while standing or sitting and she has had approximately 3 to 4 episodes of complete blackout. She also complains of occasional chest pain with lightheadedness and palpitations. Her orthopedic surgeon saw her for back pain and felt a lump in her axilla and neck, and ordered an MRI of her abdomen that revealed a right adrenal mass. CT-guided fine needle aspiration was performed of the adrenal mass.

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FNA Findings

Fine needle aspiration shows the following:

  • The smears are cellular with mostly cohesive groups of cells (fig. 1).
  • Some discohesive and loose acinar patterns are seen (fig. 2).
  • There is a prominent vascular network of capillaries within the larger cell groups (fig. 3).
  • The nuclei are mostly round to oval (fig. 4) with some scattered pseudonuclear inclusions (fig. 5).
  • There is moderate anisonucleosis with some binucleate forms present. Nucleoli are prominent (fig. 3).
  • The cytoplasm is abundant, granular, with indistinct cell borders, and appears fragile with many stripped nuclei present (fig. 5).
  • The cells appear to be connected by anastomosing strands of cytoplasm, best seen on the Papanicolaou stained smears (fig. 6).
  • The cell block shows that the cells are arranged in a nested pattern separated by a rich vascular network (fig. 7).
  • Immunohistochemical stains are performed (fig. 8).

Final Diagnosis & Discussion

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