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Imaging Features of Uncommon Adrenal Masses with Histopathologic Correlation¹

¹ From the Departments of Radiology (P.O., B.J.D., S. Mezghani, S. Musso, D.C., H.R., F.J.) and Pathology (G.E., C.M.), University Hospital Rangueil, 1 Avenue Jean-Poulhès, 31403 Toulouse 4, France. Presented as a scientific exhibit at the 1997 RSNA scientific assembly. Received April 21, 1998; revision requested May 7; final revision received October 8; accepted November 6. Address reprint requests to P.O.

View larger version (116K): [in a new window]   Figure 1a.  Type 3 hydatid cyst. US scan (a) and CT scan (b) show daughter cysts filling the lesion, which has a honeycomb appearance.

View larger version (133K): [in a new window]   Figure 1b.  Type 3 hydatid cyst. US scan (a) and CT scan (b) show daughter cysts filling the lesion, which has a honeycomb appearance.

View larger version (92K): [in a new window]   Figure 2a.  Lymphangiomatous cyst. (a) US scan shows a septated cystic mass of the right adrenal gland (arrows). (b) Contrast material–enhanced CT scan shows a lobulated cystic mass with calcified septa. (c) Spin-echo T2-weighted MR image (2,000/90 [repetition time msec/echo time msec]) shows the septa clearly due to the high signal intensity of the cystic fluid. (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows dilated vascular structures (*) with an inflammatory and fibrotic wall.

View larger version (122K): [in a new window]   Figure 2b.  Lymphangiomatous cyst. (a) US scan shows a septated cystic mass of the right adrenal gland (arrows). (b) Contrast material–enhanced CT scan shows a lobulated cystic mass with calcified septa. (c) Spin-echo T2-weighted MR image (2,000/90 [repetition time msec/echo time msec]) shows the septa clearly due to the high signal intensity of the cystic fluid. (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows dilated vascular structures (*) with an inflammatory and fibrotic wall.

View larger version (130K): [in a new window]   Figure 2c.  Lymphangiomatous cyst. (a) US scan shows a septated cystic mass of the right adrenal gland (arrows). (b) Contrast material–enhanced CT scan shows a lobulated cystic mass with calcified septa. (c) Spin-echo T2-weighted MR image (2,000/90 [repetition time msec/echo time msec]) shows the septa clearly due to the high signal intensity of the cystic fluid. (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows dilated vascular structures (*) with an inflammatory and fibrotic wall.

View larger version (164K): [in a new window]   Figure 2d.  Lymphangiomatous cyst. (a) US scan shows a septated cystic mass of the right adrenal gland (arrows). (b) Contrast material–enhanced CT scan shows a lobulated cystic mass with calcified septa. (c) Spin-echo T2-weighted MR image (2,000/90 [repetition time msec/echo time msec]) shows the septa clearly due to the high signal intensity of the cystic fluid. (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows dilated vascular structures (*) with an inflammatory and fibrotic wall.

View larger version (157K): [in a new window]   Figure 3a.  Hemangiomatous cyst. (a–c) MR images show a lobulated mass of the right adrenal gland that extends to the inferior aspect of the liver. (a) Coronal spin-echo T2-weighted MR image (2,500/138) shows a markedly hyperintense mass limited by a regular wall. (b) Sagittal fast low-angle shot (FLASH) two-dimensional gradient-echo T1-weighted MR image (122/5, 75° flip angle) shows that the mass has heterogeneous signal intensity with peripheral high signal intensity, which is consistent with hematoma. (c) Corresponding MR image obtained after intravenous injection of gadolinium contrast material shows that the mass has weak contrast enhancement, which is limited to a thin, peripheral rim. (d) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows a vascular structure with a fibrotic wall and rare residual adrenal cells (arrow).

View larger version (157K): [in a new window]   Figure 3b.  Hemangiomatous cyst. (a–c) MR images show a lobulated mass of the right adrenal gland that extends to the inferior aspect of the liver. (a) Coronal spin-echo T2-weighted MR image (2,500/138) shows a markedly hyperintense mass limited by a regular wall. (b) Sagittal fast low-angle shot (FLASH) two-dimensional gradient-echo T1-weighted MR image (122/5, 75° flip angle) shows that the mass has heterogeneous signal intensity with peripheral high signal intensity, which is consistent with hematoma. (c) Corresponding MR image obtained after intravenous injection of gadolinium contrast material shows that the mass has weak contrast enhancement, which is limited to a thin, peripheral rim. (d) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows a vascular structure with a fibrotic wall and rare residual adrenal cells (arrow).

View larger version (159K): [in a new window]   Figure 3c.  Hemangiomatous cyst. (a–c) MR images show a lobulated mass of the right adrenal gland that extends to the inferior aspect of the liver. (a) Coronal spin-echo T2-weighted MR image (2,500/138) shows a markedly hyperintense mass limited by a regular wall. (b) Sagittal fast low-angle shot (FLASH) two-dimensional gradient-echo T1-weighted MR image (122/5, 75° flip angle) shows that the mass has heterogeneous signal intensity with peripheral high signal intensity, which is consistent with hematoma. (c) Corresponding MR image obtained after intravenous injection of gadolinium contrast material shows that the mass has weak contrast enhancement, which is limited to a thin, peripheral rim. (d) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows a vascular structure with a fibrotic wall and rare residual adrenal cells (arrow).

View larger version (153K): [in a new window]   Figure 3d.  Hemangiomatous cyst. (a–c) MR images show a lobulated mass of the right adrenal gland that extends to the inferior aspect of the liver. (a) Coronal spin-echo T2-weighted MR image (2,500/138) shows a markedly hyperintense mass limited by a regular wall. (b) Sagittal fast low-angle shot (FLASH) two-dimensional gradient-echo T1-weighted MR image (122/5, 75° flip angle) shows that the mass has heterogeneous signal intensity with peripheral high signal intensity, which is consistent with hematoma. (c) Corresponding MR image obtained after intravenous injection of gadolinium contrast material shows that the mass has weak contrast enhancement, which is limited to a thin, peripheral rim. (d) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows a vascular structure with a fibrotic wall and rare residual adrenal cells (arrow).

View larger version (145K): [in a new window]   Figure 4a.  Hemangioma. (a) US scan shows a heterogeneous, hypoechoic mass. (b, c) CT scans obtained before (b) and after (c) injection of contrast material show a well-circumscribed soft-tissue mass with a punctate calcification (arrow in b) and peripheral nodular enhancement (arrow in c). (d) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after intravenous injection of gadolinium contrast material shows enhancement similar to that in the CT scan (c). (e) Corresponding MR image obtained 7 minutes later shows centripetal incomplete filling of the lesion. (f) Photograph of the gross specimen shows peripheral vascular lakes (arrows) and central fibrosis (*). (g) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows hemangiomatous proliferation dissected by a hematoma (*) and surrounded by a thick fibrotic wall (arrow). Arrowhead = residual peripheral adrenal elements.

View larger version (129K): [in a new window]   Figure 4b.  Hemangioma. (a) US scan shows a heterogeneous, hypoechoic mass. (b, c) CT scans obtained before (b) and after (c) injection of contrast material show a well-circumscribed soft-tissue mass with a punctate calcification (arrow in b) and peripheral nodular enhancement (arrow in c). (d) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after intravenous injection of gadolinium contrast material shows enhancement similar to that in the CT scan (c). (e) Corresponding MR image obtained 7 minutes later shows centripetal incomplete filling of the lesion. (f) Photograph of the gross specimen shows peripheral vascular lakes (arrows) and central fibrosis (*). (g) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows hemangiomatous proliferation dissected by a hematoma (*) and surrounded by a thick fibrotic wall (arrow). Arrowhead = residual peripheral adrenal elements.

View larger version (136K): [in a new window]   Figure 4c.  Hemangioma. (a) US scan shows a heterogeneous, hypoechoic mass. (b, c) CT scans obtained before (b) and after (c) injection of contrast material show a well-circumscribed soft-tissue mass with a punctate calcification (arrow in b) and peripheral nodular enhancement (arrow in c). (d) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after intravenous injection of gadolinium contrast material shows enhancement similar to that in the CT scan (c). (e) Corresponding MR image obtained 7 minutes later shows centripetal incomplete filling of the lesion. (f) Photograph of the gross specimen shows peripheral vascular lakes (arrows) and central fibrosis (*). (g) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows hemangiomatous proliferation dissected by a hematoma (*) and surrounded by a thick fibrotic wall (arrow). Arrowhead = residual peripheral adrenal elements.

View larger version (133K): [in a new window]   Figure 4d.  Hemangioma. (a) US scan shows a heterogeneous, hypoechoic mass. (b, c) CT scans obtained before (b) and after (c) injection of contrast material show a well-circumscribed soft-tissue mass with a punctate calcification (arrow in b) and peripheral nodular enhancement (arrow in c). (d) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after intravenous injection of gadolinium contrast material shows enhancement similar to that in the CT scan (c). (e) Corresponding MR image obtained 7 minutes later shows centripetal incomplete filling of the lesion. (f) Photograph of the gross specimen shows peripheral vascular lakes (arrows) and central fibrosis (*). (g) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows hemangiomatous proliferation dissected by a hematoma (*) and surrounded by a thick fibrotic wall (arrow). Arrowhead = residual peripheral adrenal elements.

View larger version (134K): [in a new window]   Figure 4e.  Hemangioma. (a) US scan shows a heterogeneous, hypoechoic mass. (b, c) CT scans obtained before (b) and after (c) injection of contrast material show a well-circumscribed soft-tissue mass with a punctate calcification (arrow in b) and peripheral nodular enhancement (arrow in c). (d) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after intravenous injection of gadolinium contrast material shows enhancement similar to that in the CT scan (c). (e) Corresponding MR image obtained 7 minutes later shows centripetal incomplete filling of the lesion. (f) Photograph of the gross specimen shows peripheral vascular lakes (arrows) and central fibrosis (*). (g) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows hemangiomatous proliferation dissected by a hematoma (*) and surrounded by a thick fibrotic wall (arrow). Arrowhead = residual peripheral adrenal elements.

View larger version (124K): [in a new window]   Figure 4f.  Hemangioma. (a) US scan shows a heterogeneous, hypoechoic mass. (b, c) CT scans obtained before (b) and after (c) injection of contrast material show a well-circumscribed soft-tissue mass with a punctate calcification (arrow in b) and peripheral nodular enhancement (arrow in c). (d) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after intravenous injection of gadolinium contrast material shows enhancement similar to that in the CT scan (c). (e) Corresponding MR image obtained 7 minutes later shows centripetal incomplete filling of the lesion. (f) Photograph of the gross specimen shows peripheral vascular lakes (arrows) and central fibrosis (*). (g) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows hemangiomatous proliferation dissected by a hematoma (*) and surrounded by a thick fibrotic wall (arrow). Arrowhead = residual peripheral adrenal elements.

View larger version (157K): [in a new window]   Figure 4g.  Hemangioma. (a) US scan shows a heterogeneous, hypoechoic mass. (b, c) CT scans obtained before (b) and after (c) injection of contrast material show a well-circumscribed soft-tissue mass with a punctate calcification (arrow in b) and peripheral nodular enhancement (arrow in c). (d) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after intravenous injection of gadolinium contrast material shows enhancement similar to that in the CT scan (c). (e) Corresponding MR image obtained 7 minutes later shows centripetal incomplete filling of the lesion. (f) Photograph of the gross specimen shows peripheral vascular lakes (arrows) and central fibrosis (*). (g) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows hemangiomatous proliferation dissected by a hematoma (*) and surrounded by a thick fibrotic wall (arrow). Arrowhead = residual peripheral adrenal elements.

View larger version (141K): [in a new window]   Figure 5a.  Ganglioneuroma. (a) Spin-echo T2-weighted MR image (2,000/90) shows a moderately hyperintense mass. (b) T1-weighted MR image (690/12) shows a homogeneously hypointense mass. The lesion is close to the inferior vena cava (*) and pancreatic head (arrow). (c) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after injection of gadolinium contrast material shows enhancement of only fine septa. (d, e) Corresponding MR images obtained 2 minutes (d) and 4 minutes (e) after contrast material injection show delayed incomplete filling of the mass. (f) Photograph of the gross specimen shows a densely fibrous, well-limited tumor. Scale is in centimeters. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows bundles of ganglion cells (*) encompassing the adrenal gland (arrow).

View larger version (138K): [in a new window]   Figure 5b.  Ganglioneuroma. (a) Spin-echo T2-weighted MR image (2,000/90) shows a moderately hyperintense mass. (b) T1-weighted MR image (690/12) shows a homogeneously hypointense mass. The lesion is close to the inferior vena cava (*) and pancreatic head (arrow). (c) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after injection of gadolinium contrast material shows enhancement of only fine septa. (d, e) Corresponding MR images obtained 2 minutes (d) and 4 minutes (e) after contrast material injection show delayed incomplete filling of the mass. (f) Photograph of the gross specimen shows a densely fibrous, well-limited tumor. Scale is in centimeters. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows bundles of ganglion cells (*) encompassing the adrenal gland (arrow).

View larger version (161K): [in a new window]   Figure 5c.  Ganglioneuroma. (a) Spin-echo T2-weighted MR image (2,000/90) shows a moderately hyperintense mass. (b) T1-weighted MR image (690/12) shows a homogeneously hypointense mass. The lesion is close to the inferior vena cava (*) and pancreatic head (arrow). (c) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after injection of gadolinium contrast material shows enhancement of only fine septa. (d, e) Corresponding MR images obtained 2 minutes (d) and 4 minutes (e) after contrast material injection show delayed incomplete filling of the mass. (f) Photograph of the gross specimen shows a densely fibrous, well-limited tumor. Scale is in centimeters. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows bundles of ganglion cells (*) encompassing the adrenal gland (arrow).

View larger version (159K): [in a new window]   Figure 5d.  Ganglioneuroma. (a) Spin-echo T2-weighted MR image (2,000/90) shows a moderately hyperintense mass. (b) T1-weighted MR image (690/12) shows a homogeneously hypointense mass. The lesion is close to the inferior vena cava (*) and pancreatic head (arrow). (c) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after injection of gadolinium contrast material shows enhancement of only fine septa. (d, e) Corresponding MR images obtained 2 minutes (d) and 4 minutes (e) after contrast material injection show delayed incomplete filling of the mass. (f) Photograph of the gross specimen shows a densely fibrous, well-limited tumor. Scale is in centimeters. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows bundles of ganglion cells (*) encompassing the adrenal gland (arrow).

View larger version (160K): [in a new window]   Figure 5e.  Ganglioneuroma. (a) Spin-echo T2-weighted MR image (2,000/90) shows a moderately hyperintense mass. (b) T1-weighted MR image (690/12) shows a homogeneously hypointense mass. The lesion is close to the inferior vena cava (*) and pancreatic head (arrow). (c) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after injection of gadolinium contrast material shows enhancement of only fine septa. (d, e) Corresponding MR images obtained 2 minutes (d) and 4 minutes (e) after contrast material injection show delayed incomplete filling of the mass. (f) Photograph of the gross specimen shows a densely fibrous, well-limited tumor. Scale is in centimeters. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows bundles of ganglion cells (*) encompassing the adrenal gland (arrow).

View larger version (154K): [in a new window]   Figure 5f.  Ganglioneuroma. (a) Spin-echo T2-weighted MR image (2,000/90) shows a moderately hyperintense mass. (b) T1-weighted MR image (690/12) shows a homogeneously hypointense mass. The lesion is close to the inferior vena cava (*) and pancreatic head (arrow). (c) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after injection of gadolinium contrast material shows enhancement of only fine septa. (d, e) Corresponding MR images obtained 2 minutes (d) and 4 minutes (e) after contrast material injection show delayed incomplete filling of the mass. (f) Photograph of the gross specimen shows a densely fibrous, well-limited tumor. Scale is in centimeters. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows bundles of ganglion cells (*) encompassing the adrenal gland (arrow).

View larger version (142K): [in a new window]   Figure 5g.  Ganglioneuroma. (a) Spin-echo T2-weighted MR image (2,000/90) shows a moderately hyperintense mass. (b) T1-weighted MR image (690/12) shows a homogeneously hypointense mass. The lesion is close to the inferior vena cava (*) and pancreatic head (arrow). (c) FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained immediately after injection of gadolinium contrast material shows enhancement of only fine septa. (d, e) Corresponding MR images obtained 2 minutes (d) and 4 minutes (e) after contrast material injection show delayed incomplete filling of the mass. (f) Photograph of the gross specimen shows a densely fibrous, well-limited tumor. Scale is in centimeters. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows bundles of ganglion cells (*) encompassing the adrenal gland (arrow).

View larger version (127K): [in a new window]   Figure 6a.  Angiosarcoma. (a) Contrast-enhanced CT scan shows a mass with soft-tissue attenuation and punctate calcifications. Enhancement is intense peripherally, and the center of the lesion appears necrotic. There is an associated intrahepatic hematoma (*) due to local hemorrhage from the tumor. (b) Coronal FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained after injection of contrast material shows intense peripheral enhancement, which reveals the necrotic center. The adjacent hematoma appears as a cystic lesion. (c) Photograph of the gross specimen shows a bulky, irregular mass with internal vascular lakes. (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows vascular clefts (*) lined with one or more layers of tumor cells.

View larger version (115K): [in a new window]   Figure 6b.  Angiosarcoma. (a) Contrast-enhanced CT scan shows a mass with soft-tissue attenuation and punctate calcifications. Enhancement is intense peripherally, and the center of the lesion appears necrotic. There is an associated intrahepatic hematoma (*) due to local hemorrhage from the tumor. (b) Coronal FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained after injection of contrast material shows intense peripheral enhancement, which reveals the necrotic center. The adjacent hematoma appears as a cystic lesion. (c) Photograph of the gross specimen shows a bulky, irregular mass with internal vascular lakes. (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows vascular clefts (*) lined with one or more layers of tumor cells.

View larger version (113K): [in a new window]   Figure 6c.  Angiosarcoma. (a) Contrast-enhanced CT scan shows a mass with soft-tissue attenuation and punctate calcifications. Enhancement is intense peripherally, and the center of the lesion appears necrotic. There is an associated intrahepatic hematoma (*) due to local hemorrhage from the tumor. (b) Coronal FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained after injection of contrast material shows intense peripheral enhancement, which reveals the necrotic center. The adjacent hematoma appears as a cystic lesion. (c) Photograph of the gross specimen shows a bulky, irregular mass with internal vascular lakes. (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows vascular clefts (*) lined with one or more layers of tumor cells.

View larger version (158K): [in a new window]   Figure 6d.  Angiosarcoma. (a) Contrast-enhanced CT scan shows a mass with soft-tissue attenuation and punctate calcifications. Enhancement is intense peripherally, and the center of the lesion appears necrotic. There is an associated intrahepatic hematoma (*) due to local hemorrhage from the tumor. (b) Coronal FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) obtained after injection of contrast material shows intense peripheral enhancement, which reveals the necrotic center. The adjacent hematoma appears as a cystic lesion. (c) Photograph of the gross specimen shows a bulky, irregular mass with internal vascular lakes. (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows vascular clefts (*) lined with one or more layers of tumor cells.

View larger version (132K): [in a new window]   Figure 7.  Primary malignant melanoma. Contrast-enhanced CT scan shows a necrotic and calcified adrenal mass (*) with associated hepatic metastases (arrow). (Courtesy of J. L. Puech, MD, Clinique Saint-Jean Languedoc, Toulouse, France.)

View larger version (119K): [in a new window]   Figure 8a.  Myelolipoma. (a) US scan shows a hyperechoic, well-limited mass of the right adrenal gland. (b) CT scan obtained after injection of contrast material shows a well-defined mass with hypoattenuating areas, which indicate a fat content. (c) Spin-echo T1-weighted MR image (690/12) shows high signal intensity in some areas of the tumor (arrows). This high signal intensity is comparable with that of fat. (d) Photograph of the gross specimen shows an association of soft-tissue (*) and fatty (arrows) components.

View larger version (117K): [in a new window]   Figure 8b.  Myelolipoma. (a) US scan shows a hyperechoic, well-limited mass of the right adrenal gland. (b) CT scan obtained after injection of contrast material shows a well-defined mass with hypoattenuating areas, which indicate a fat content. (c) Spin-echo T1-weighted MR image (690/12) shows high signal intensity in some areas of the tumor (arrows). This high signal intensity is comparable with that of fat. (d) Photograph of the gross specimen shows an association of soft-tissue (*) and fatty (arrows) components.

View larger version (133K): [in a new window]   Figure 8c.  Myelolipoma. (a) US scan shows a hyperechoic, well-limited mass of the right adrenal gland. (b) CT scan obtained after injection of contrast material shows a well-defined mass with hypoattenuating areas, which indicate a fat content. (c) Spin-echo T1-weighted MR image (690/12) shows high signal intensity in some areas of the tumor (arrows). This high signal intensity is comparable with that of fat. (d) Photograph of the gross specimen shows an association of soft-tissue (*) and fatty (arrows) components.

View larger version (151K): [in a new window]   Figure 8d.  Myelolipoma. (a) US scan shows a hyperechoic, well-limited mass of the right adrenal gland. (b) CT scan obtained after injection of contrast material shows a well-defined mass with hypoattenuating areas, which indicate a fat content. (c) Spin-echo T1-weighted MR image (690/12) shows high signal intensity in some areas of the tumor (arrows). This high signal intensity is comparable with that of fat. (d) Photograph of the gross specimen shows an association of soft-tissue (*) and fatty (arrows) components.

View larger version (110K): [in a new window]   Figure 9a.  Collision tumor with associated myelolipoma and adenoma. (a) Contrast-enhanced CT scan shows a regular, ovoid mass of the right adrenal gland with a fatty component (-84 HU). (b) Coronal FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) shows a heterogeneous mass with some well-limited hyperintense areas (arrow). (c) T2-weighted MR image (2,000/90) shows that these areas (arrow) have the same high signal intensity as retroperitoneal fat. (d) T1-weighted MR image (690/12) obtained with fat suppression shows heterogeneous enhancement and the lipidic nature of the corresponding areas (arrow). (e) Photograph of the gross specimen shows the lipidic areas as yellow nodules (arrowheads). (f) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows the association of adenomatous tissue (white *), fatty tissue (solid arrow), fibrotic tissue (open arrow), and hemorrhagic vascular structures (black *).

View larger version (155K): [in a new window]   Figure 9b.  Collision tumor with associated myelolipoma and adenoma. (a) Contrast-enhanced CT scan shows a regular, ovoid mass of the right adrenal gland with a fatty component (-84 HU). (b) Coronal FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) shows a heterogeneous mass with some well-limited hyperintense areas (arrow). (c) T2-weighted MR image (2,000/90) shows that these areas (arrow) have the same high signal intensity as retroperitoneal fat. (d) T1-weighted MR image (690/12) obtained with fat suppression shows heterogeneous enhancement and the lipidic nature of the corresponding areas (arrow). (e) Photograph of the gross specimen shows the lipidic areas as yellow nodules (arrowheads). (f) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows the association of adenomatous tissue (white *), fatty tissue (solid arrow), fibrotic tissue (open arrow), and hemorrhagic vascular structures (black *).

View larger version (152K): [in a new window]   Figure 9c.  Collision tumor with associated myelolipoma and adenoma. (a) Contrast-enhanced CT scan shows a regular, ovoid mass of the right adrenal gland with a fatty component (-84 HU). (b) Coronal FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) shows a heterogeneous mass with some well-limited hyperintense areas (arrow). (c) T2-weighted MR image (2,000/90) shows that these areas (arrow) have the same high signal intensity as retroperitoneal fat. (d) T1-weighted MR image (690/12) obtained with fat suppression shows heterogeneous enhancement and the lipidic nature of the corresponding areas (arrow). (e) Photograph of the gross specimen shows the lipidic areas as yellow nodules (arrowheads). (f) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows the association of adenomatous tissue (white *), fatty tissue (solid arrow), fibrotic tissue (open arrow), and hemorrhagic vascular structures (black *).

View larger version (151K): [in a new window]   Figure 9d.  Collision tumor with associated myelolipoma and adenoma. (a) Contrast-enhanced CT scan shows a regular, ovoid mass of the right adrenal gland with a fatty component (-84 HU). (b) Coronal FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) shows a heterogeneous mass with some well-limited hyperintense areas (arrow). (c) T2-weighted MR image (2,000/90) shows that these areas (arrow) have the same high signal intensity as retroperitoneal fat. (d) T1-weighted MR image (690/12) obtained with fat suppression shows heterogeneous enhancement and the lipidic nature of the corresponding areas (arrow). (e) Photograph of the gross specimen shows the lipidic areas as yellow nodules (arrowheads). (f) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows the association of adenomatous tissue (white *), fatty tissue (solid arrow), fibrotic tissue (open arrow), and hemorrhagic vascular structures (black *).

View larger version (116K): [in a new window]   Figure 9e.  Collision tumor with associated myelolipoma and adenoma. (a) Contrast-enhanced CT scan shows a regular, ovoid mass of the right adrenal gland with a fatty component (-84 HU). (b) Coronal FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) shows a heterogeneous mass with some well-limited hyperintense areas (arrow). (c) T2-weighted MR image (2,000/90) shows that these areas (arrow) have the same high signal intensity as retroperitoneal fat. (d) T1-weighted MR image (690/12) obtained with fat suppression shows heterogeneous enhancement and the lipidic nature of the corresponding areas (arrow). (e) Photograph of the gross specimen shows the lipidic areas as yellow nodules (arrowheads). (f) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows the association of adenomatous tissue (white *), fatty tissue (solid arrow), fibrotic tissue (open arrow), and hemorrhagic vascular structures (black *).

View larger version (146K): [in a new window]   Figure 9f.  Collision tumor with associated myelolipoma and adenoma. (a) Contrast-enhanced CT scan shows a regular, ovoid mass of the right adrenal gland with a fatty component (-84 HU). (b) Coronal FLASH two-dimensional gradient-echo T1-weighted MR image (690/12) shows a heterogeneous mass with some well-limited hyperintense areas (arrow). (c) T2-weighted MR image (2,000/90) shows that these areas (arrow) have the same high signal intensity as retroperitoneal fat. (d) T1-weighted MR image (690/12) obtained with fat suppression shows heterogeneous enhancement and the lipidic nature of the corresponding areas (arrow). (e) Photograph of the gross specimen shows the lipidic areas as yellow nodules (arrowheads). (f) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows the association of adenomatous tissue (white *), fatty tissue (solid arrow), fibrotic tissue (open arrow), and hemorrhagic vascular structures (black *).

View larger version (141K): [in a new window]   Figure 10a.  Collision tumor with associated myelolipoma and adenoma. (a, b) Nonenhanced (a) and contrast-enhanced (b) CT scans show a heterogeneous mass of the left adrenal gland. The mass represents the association of a soft-tissue mass, calcification, and a fatty component. (c) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows a sharp demarcation between myelolipomatous (left side of image) and adenomatous (right side of image) elements.

View larger version (164K): [in a new window]   Figure 10b.  Collision tumor with associated myelolipoma and adenoma. (a, b) Nonenhanced (a) and contrast-enhanced (b) CT scans show a heterogeneous mass of the left adrenal gland. The mass represents the association of a soft-tissue mass, calcification, and a fatty component. (c) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows a sharp demarcation between myelolipomatous (left side of image) and adenomatous (right side of image) elements.

View larger version (169K): [in a new window]   Figure 10c.  Collision tumor with associated myelolipoma and adenoma. (a, b) Nonenhanced (a) and contrast-enhanced (b) CT scans show a heterogeneous mass of the left adrenal gland. The mass represents the association of a soft-tissue mass, calcification, and a fatty component. (c) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows a sharp demarcation between myelolipomatous (left side of image) and adenomatous (right side of image) elements.