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Low-Density Pheochromocytoma on CT: A Mimicker of Adrenal Adenoma

Michael A. Blake1, Saravanan K. Krishnamoorthy1, Giles W. Boland1, Ann T. Sweeney2, Martha B. Pitman3, Mukesh Harisinghani1, Peter R. Mueller1 and Peter F. Hahn1

1 Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St., White 270, Boston, MA 02114.
2 Department of Medicine, Division of Endocrinology, St. Elizabeth's Medical Center, 736 Cambridge St., Boston, MA 02135.
3 Department of Pathology, Massachusetts General Hospital, Boston, MA 02114.



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  		Fig. 1A. —57-year-old man with medullary hyperplasia producing pheochromocytoma syndrome. CT scan shows 0.8-cm left adrenal nodule (arrow) with 1.8-H attenuation.

 


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  		Fig. 1B. —57-year-old man with medullary hyperplasia producing pheochromocytoma syndrome. Photograph of gross pathologic specimen shows enlarged medulla (arrow) composed of tissue surrounded by fat-containing adrenal cortical cells.

 


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  		Fig. 1C. —57-year-old man with medullary hyperplasia producing pheochromocytoma syndrome. Photomicrographs of histopathologic specimens show fat-containing cortical cells (arrow) that are intermingled with hyperplastic dark medullary cells in enlarged medulla. (C, H and E, x40; D, H and E, x200)

 


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  		Fig. 1D. —57-year-old man with medullary hyperplasia producing pheochromocytoma syndrome. Photomicrographs of histopathologic specimens show fat-containing cortical cells (arrow) that are intermingled with hyperplastic dark medullary cells in enlarged medulla. (C, H and E, x40; D, H and E, x200)

 


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  		Fig. 2A. —49-year-old woman with low-density pheochromocytoma who has neurofibromatosis 1. CT scan shows rounded low-density right adrenal mass (arrow) with attenuation value of 9 H.

 


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  		Fig. 2B. —49-year-old woman with low-density pheochromocytoma who has neurofibromatosis 1. Photomicrograph of histopathologic specimen shows classic pheochromocytoma. Note areas of medullary cells containing abundant intracytoplasmic fat seen as diffuse bubbly (fatty) cytoplasm. (H and E, x400)

 

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