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Residents' Teaching Files

Adrenal Adenoma and Hematoma Mimicking a Collision Tumor at MR Imaging

¹ Departments of Radiology (N.J.K., M.C.J.)
² Pathology (A.M.S.), The George Washington University Medical Center, 901 23rd St, NW, Washington, DC 20037.

View larger version (150K): [in a new window]   Figure 1.  Axial contrast-enhanced CT scan of the abdomen shows a 3.5-cm mass in the left adrenal gland (arrow). The mass has a smooth contour and sharp margins.

View larger version (125K): [in a new window]   Figure 2a.  (a) Axial T1-weighted fast spin-echo (repetition time msec/echo time msec = 749/12) MR image of the abdomen obtained at the level of the adrenal glands shows a heterogeneously hypointense left adrenal mass. Note the area of intermediate signal intensity (from subacute blood) within the mass (arrowhead). (b) Axial T2-weighted fast spin-echo (3,150/102) MR image shows the left adrenal mass (arrow) as slightly heterogeneous and nearly isointense relative to the liver.

View larger version (154K): [in a new window]   Figure 2b.  (a) Axial T1-weighted fast spin-echo (repetition time msec/echo time msec = 749/12) MR image of the abdomen obtained at the level of the adrenal glands shows a heterogeneously hypointense left adrenal mass. Note the area of intermediate signal intensity (from subacute blood) within the mass (arrowhead). (b) Axial T2-weighted fast spin-echo (3,150/102) MR image shows the left adrenal mass (arrow) as slightly heterogeneous and nearly isointense relative to the liver.

View larger version (158K): [in a new window]   Figure 3a.  (a) Axial in-phase gradient-echo (36.5/4.2) MR image shows the left adrenal mass with homogeneous low signal intensity (isointense relative to the spleen). (b) Axial opposed-phase gradient-echo (32.1/2.5) MR image obtained at the level of the left adrenal mass shows signal dropout peripherally with an eccentric area of higher signal intensity (arrow). This high-signal-intensity area corresponds to the coexistent hematoma.

View larger version (178K): [in a new window]   Figure 3b.  (a) Axial in-phase gradient-echo (36.5/4.2) MR image shows the left adrenal mass with homogeneous low signal intensity (isointense relative to the spleen). (b) Axial opposed-phase gradient-echo (32.1/2.5) MR image obtained at the level of the left adrenal mass shows signal dropout peripherally with an eccentric area of higher signal intensity (arrow). This high-signal-intensity area corresponds to the coexistent hematoma.

View larger version (194K): [in a new window]   Figure 4a.  (a) Low-power photomicrograph (original magnification, x20; hematoxylin-eosin stain) demonstrates a cystic hemorrhagic area (arrows). (b) High-power photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows a highly vascular clear cell cortical adenoma (arrows) adjacent to the cystic hemorrhagic area deforming the normal architecture of the adrenal gland.

View larger version (164K): [in a new window]   Figure 4b.  (a) Low-power photomicrograph (original magnification, x20; hematoxylin-eosin stain) demonstrates a cystic hemorrhagic area (arrows). (b) High-power photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows a highly vascular clear cell cortical adenoma (arrows) adjacent to the cystic hemorrhagic area deforming the normal architecture of the adrenal gland.