WSI23-12: Endocrine

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Topic Endocrine

Date and time Wednesday, June 19, 2024 12:00 PM

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Case	Clinical history	Requester	Diagnosis
Case	Clinical history	Requester	Diagnosis
Case 1	54 year old female	Si787	Granulomatous thyroiditis possibly associated with deQuervain's thyroiditis or a drug reaction
Case 2	44 year old female	Si787	PTC • encapsulated follicular variant with clear cell morphology
Case 3	36 year old female	Si787	PTC • encapsulated follicular variant • minimally invasive (5.0 cm) • intrathyroidal
Case 4	40 year old female with a circumscribed 5.1 cm right thyroid lobe mass suspicious for malignancy (papillary thyroid carcinoma) by FNA cytology biopsy • initially diagnosed as papillary thyroid carcinoma • follicular variant	Si787	Follicular thyroid adenoma (5.1 cm); differential diagnosis includes FT-UMP • NIFTP • WDT-UMP and invasive encapsulated follicular variant of papillary thyroid carcinoma
Case 5	41 year old male	Si787	PTC • classical type (3.1 cm) • encapsulated.
Case 6	72 year old male	Si787	Papillary thyroid microcarcinoma (<0.1 cm)
Case 7	69 year old female	Si787	PTC • clear cell type
Case 8	63 year old female	Si787	Predominantly microfollicular adenomatous nodule
Case 9	22 year old female	Si787	PTC • tall cell variant
Case 10	23 year old female	Si787	PTC • tall cell variant
Case 11	26 year old female	Si787	PTC • diffuse sclerosing variant
Case 12	51 year old female	Si787	Ciliated respiratory epithelial-lined inclusion cyst (1.1 cm) • benign
Case 13	61 year old male	Si787	PTC • classical type
Case 14	40-year-old-female with 2.1 cm well-circumscribed mass.	Si787	Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP); positive for HBME1 and negative for BRAF
Case 15	83 year old female	Si787	Enlarged (1.8 g) hypercellular parathyroid with marked reduction in intracellular fat
Case 16	68 year old female	Si787	Minimally invasive follicular thyroid carcinoma • oncocytic type
Case 17	72 year old female	Si787	Hurthle cell adenoma with metastatic endometrial adenocarcinoma. Papillary thyroid microcarcinoma.
Case 18	61 year old male	Si787	PTC • classical type
Case 19	18 year old female	Si787	PTC • oncocytic variant (4.8 cm)
Case 20	22 year old female	Si787	PTC • tall cell variant
Case 21	26 year old female	Si787	Metastatic papillary thyroid carcinoma
Case 22	55 year old female	Si787	Minimally invasive follicular thyroid carcinoma
Case 23	49 year old female	Si787	PTC • encapsulated follicular vairant with focal calcification (2.2 cm) • intrathyroidal
Case 24	68 year old female with visual disturbance and expressive aphasia	Si787	Undifferentiated (anaplastic) thyroid carcinoma. Frameshif mutation PTEN and P53
Case 25	34 year old female	Si787	Hyalinizing trabecular tumor (0.9 cm) negative for malignancy
Case 26	47 year old male with right thyroid mass with history of XRT and chemotherapy 29 and 27 years ago • respectively for initial and recurrent Hodgkin lymphoma	Si787	High grade mucoepidermoid carcnoma (at least 2.2 cm) + ETE • + PN1
Case 27	39 year old female	Si787	PTC • hobnail variant
Case 28	48 year old female with left sided thyroid mass noted by her gyn	Si787	PTC • classical type with Hobnail features and squamous metaplasia. + LVI • + multiple nodes
Case 29	46 year old male with 2.1 cm mass in the right thyroid lobe with numerous mets to mediastinum and neck nodes	Si787	Medullary thyroid carcinoma met 30/34 R necknodules and mediastinum
Case 30	64 year old female who presents 2+ months prior with "lump in her throat" and associated discomfort • including hoarseness and dysphagia with pills	Si787	Poorly differentiated thyroid carcinoma (7.1 cm) arising in association with PTC with PTC LN metastasis
Case 31	66 year old male with large thyroid mass	Si787	Undifferentiated (anaplastic) thyroid carcinoma arising in association with PTC • classical variant
Case 32	72 year old female with prior XRT for endometrial cancer now with a thyroid mass	Si787	Hurthle cell adenoma (2.9 cm) with metastatic endometrioid endometrial carcinoma • intralesional
Case 33	53 year old female with dysphagia and mass occupying the left lobe of the thyroid	Si787	Paranganglioma
Case 34	49 year old female with treatment refractory Graves disease	Si787	Graves disese -- diffuse nodular papillary hyperplasia
Case 35	50 year old male with h/o tall cell papillary thyroid carcinoma with bulky neck disease	Si787	Metastatic undifferentiated (anaplastic) thyroid carcinoma
Case 36	53 year old male with thyroid fullness • assymptomatic • noted on physical exam by PCP at routine visit	Si787	Medullary thyroid carcinoma with dominant 1.2 cm L mass. + LVI • + mult mets (neck) • + margin. Surgery with amplifications post-op increased calcitonin
Case 37	87 year old female with left superior aspect thyroid mass	Si787	MTC (1.7 cm)
Case 38	88 year old female with SOB • and difficulty swallowing - 1 yr ultrasound shows L-sided thyroid mass	Si787	PTC • Warthin tumor-like variant (5.8 cm) with LVI.
Case 39	30 year old male with enlarged thyroid and hyperthyroidism	Si787	Multinodular papillary hyperplasia c/w Graves disease
Case 40	19 year old female with thyroid cancer	Si787	PTC • diffuse sclerosing variant with bulky left-sided nodal involvement
Case 41	64 year old male with large • left lower aspect thyroid mass	Si787	PTC (1.5 cm) with oncocytic and hobnail features
Case 42	65 year old male with elevated TSH which prompted U/S - 5.5 cm left thyroid mass with enlarged lymph nodes	Si787	Squamous cell carcinoma of the thyroid (7.1 cm) with extrathyroidal extension pT4a NO MX (AJCC 7th ed)
Case 43	72 year old female noticed a lump in her neck with thyroidectomy performed four months later for follicular neoplasm	Si787	Angioinvasive follicular thyroid carcinoma (2.6 cm) R completely excised with focal LVI and capsular invasion
Case 44	62 year old woman with significant past medical history presents with a multinodular thyroid and 1.8 cm dominant right-sided mass called + neoplastic cells on FNA	Si787	Metastatic leiomyosarcoma (1.8 cm) nodular Hashimoto thyroiditis. h/o leiomyosarcoma of uterus with lung metastasis
Case 45	Cleveland Clinic - 59 year old female with 3.3 cm neck mass	Si787	PTC • columnar cell variant
Case 46	81 year old male with biopsy (outside) of thyroid + papillary thyroid carcinoma	Si787	Extranodal marginal zone lymphoma (MALT-type) arising in a background of profound chronic lymphocytic (Hashimoto) thyroiditis with a dominant 2.1 cm nodule with necrosis (likely oncocytic and likely what was erroneously called PTC earlier])
Case 47	54 year old female with right thyroid mass	Si787	Benign cyst (3.8 cm) - not this slide. Papillary thyroid microcarcinoma (0.2 cm) arising in a mixed micro and macrofollicular adenoma (0.8 cm)
Case 48	55 year old male with left thyroid nodule	Si787	Medullary thyroid carcinoma (1.1 cm)
Case 49	41 year old female with follicular lesion with atypia of right thyroid lobe	Si787	Follicular adenoma (oncocytic) with oncocytic atypia. Two microcarcinomas. Micro HBME • galectin + • Adenoma HBME • galectin -
Case 50	14 year old female with 5.5 cm cystic lesion of the thyroid	Si787	Bronchogenic cyst
Case 51	38 year old female with Hashimoto thyroiditis and bilateral thyroid nodules	Si787	Hyalinizing trabecular tumor (0.8 cm)
Case 52	48 year old female with bilateral neck disease and bilateral thyroid lesions	Si787	PTC • classical type with osseous metaplasia • two foci 1.7 and 1.3 cm. +BRAF both
Case 53	21 year old female 5.8 cm mass replascing thyroid with evidence of esophageal involvement and multiple lymph nodes involved • including mediastinal	Si787	PTC • diffuse sclerosing variant
Case 54	22 year old with effaced left thyroid lobe and lymph adenopathy	Si787	PTC • multifocal with fx of diffuse sclerosing variant • involving the majority of the left lobe • lower aspect of R lobe with extrathyroidal extension • invasion of adjacent parathyroid • positive margins • LVI and bilateral LN involvemennt
Case 55	26 year old female with bilateral thyroid nodules	Si787	PTC • diffuse sclerosing variant
Case 56	13 year old female with thyroid follicular nodular disease and hypothyroidism	Si787	Diffuse sclerosing papillary thyroid carcinoma with LVI • + margins • + gross ETE • invasion of thymus • + mult + LN; CCDC6::RET
Case 57	66 year old female with thyroid mass	Si787	PTC • oncocytic variant with tall cell featrures (1.9 cm) 0.7 cm 2nd focus same morphology. BRAFVE +
Case 58	51 year old male with left lobe lesion	Si787	Atypical folliculra adenoma with a pronounced trabecular growth pattern (2.6 cm)
Case 59	44 year old female with multiple thyroid nodules and a dominant • calcified 0.9 cm nodule	Si787	Multiple solid • microfollicular adenomatous nodules raise the possibility of Cowden syndrome
Case 60	34 year old female with 4.8 cm nodule left lobe	Si787	Papillary thyroid carcinoma • macarofollicular
Case 61	62 year old male with right thyroid cyst	Si787	Benign unilocular epithelial cyst
Case 62	73 year old with central neck mass s/p 3 surgeries	Si787	Poorly differentiated carcinoma involving peritracheal ST • met PTC hobnail variant to LN and PDL as well in LN
Case 63	52 year old female with h/o mitral regurgitation • hematuria • anxiety • and endometriosis. Right-sided (thyroid) disese with bulky lymphadenopathy • possibley with nerve involvement - right lobectomy (FNA called PTC)	Si787	Medullary thyroid carcinoma (7.0 cm) extrathyroidal • + margin lymph node mets
Case 64	79 year old male who presents with changes in phonation and a thyroid mass	Si787	PTC with high-grade features and foci of undifferentiated carcioma with PTC in lymph node mets
Case 65	82 year old who presents with hoarseness	Si787	Undifferentiated (anaplastic) thyroid carcinoma • osteoclast-like variant arising in association with poorly differentiated carcinoma and oncocytic follicular carcinoma presents with lung mets as well
Case 66	73 year old female with suspicious thyroid nodules with total thyroidectomy	Si787	Atypical oncocytic neoplasm (adenoma) • 1.8 cm
Case 67	70 year old female presented with severe chest tightness • shortness of breath and afib in Oct. 2008. U/S showed 5.7 left thyroid mass but b/L nodules and LAD CT showed multiple lung nodules	Si787	Undifferentiated (anaplastic) carcnoma of the thyroid 7.4 cm with extensive ETE to skeletal muscle and ST and large vessels. + LNs
Case 68	62 year old male with widely metastatic renal cell carcinoma who presents with a thyroid mass with tracheal invasion on routine f/u	Si787	Metastatic renal cell carcinoma • invaisve through tracheal cartilage and involving both tracheal mucosa and peritracheal soft tissue with LVI. High gradepapillary thyroid carcinoma • colliding with RCC at the junction of the tracheal cartilage with extensive LVI.
Case 69	15 year old female with non-toxic multinodular goiter	Si787	Atypical papillary hyperplastic lesion with oncocytic features (1.6 cm) • intrathyroidal
Case 70	60 year old male with h/o thyroid nodules in 1980s s/p L excision for benign lesion. Now with b/L nodules and L lobectomy	Si787	Benign lymphoepithelial cysts (1.8 and 1.0 cm). Fibrotic • lobultaed degenerative area 1.1 cm. TINEN.
Case 71	35 year old female with circumscribed left lobe thyroid nodule	Si787	Mixed micro and macrofollicular adenoma with hyperplastic changes and focal nuclear atypia
Case 72	70 year old female with bilateral thyroid nodules	Si787	Papillary thyroid microcarcinoma. Pigmented with clear cell change.
Case 73	25 year old female with thyroid mass and lymphadenopathy	Si787	PTC • diffuse sclerosing variant with LVI • extrathyroidal extension • and lymph node mets
Case 74	61 year old male with Graves disease and a thyroglossal duct cyst	Si787	PTC with features of Warthin-like variant and tall cell variant in the setting of florid Graves disease
Case 75	38 year old female with thyroglossal duct cyst	Si787	PTC • cystic • associated with thyroglossal duct cyst or adjacent pyramidal lobe
Case 76	56 year old female with goiter (113 gm) and 1.4 cm nodule	Si787	PTC with Warthin tumor-like and oncocytic features
Case 77	66 year old woman with thyroid nodules and dominant left 1.8 cm nodule	Si787	Wide invasive Hurthle cell carcinoma with agioinvasion and neuroendocrine differentiation. + synapto • + CD56 • + PAX8 • - CEA • - chromo
Case 78	54 year old female with h/o HTN • ESRD on hemodialysis with R neck mass. CT/VIS shows R LAD and R thyroid nodule - bx cervical node	Si787	c/w metastatic PTC. + TTF1 • PAX8 • HBME • thyroglobulin. BRAF equivocal
Case 79	28 year old male with h/o cardiac arrest s/p total thyroidectomy for amiodarone-induced thyrotoxicosis	Si787	c/w amiodarone-induced thyrotoxicosis
Case 80	55 year old female with right thyroid neoplasm	Si787	Minimally invasive follicular thyroid carcinoma • oncocytic type 1.8 cm
Case 81	66 year old male with a right thyroid nodule	Si787	Microfollicular adenoma • clear cell type (3.4 cm) with no evidence of malignancy
Case 82	28 year old female with thyroid nodule	Si787	PTC • encapsulated clear cell variant
Case 83	61 year old male with hoarseness and dysphagia. Neck u/s showed 2.3 cm R thyroid nodule. FNA - follicular neoplasm	Si787	Widely invasive follicular thyroid carcinoma (4.2 cm) with clear cell features and extensive lymphovascular invasion and extrathyroidal extension. Hip lesion also present
Case 84	64 year old female with thyroid mass and lytic lesion of the humerous. Thyroid is excised.	Si787	PTC • clear cell variant with extensive solid and insular growth pattern worrisome for evolution toward poorly diff.
Case 85	37 year old female with hypothyroidism	Si787	Chronic lymphocytic (Hashimoto) thyroiditis • fibrous variant. IgG4-rich. Not necessarily associated with systemic disease in the thyroid but should be excluded
Case 86	65 year old male with lesions involving tonsils (B) • hyphopharynx (B) • base of tongue • nasopharyx • thyroid (B) • and lung • multifocal	Si787	Papillary carcinoma • TTF1 + • lung vs thyroid
Case 87	74 year old man with 341 gm thyroid and a 4.5 cm mass	Si787	Follicular thyroid carcinoma • oncocytic (Hurthle cell) type with multifocal angiovinvasion and additional high grade features
Case 88	46 year old female with 144 g goiter and dominent 3.5 cm mass	Si787	Multinodular hyperplasdia with a 3.5 cm atypical follicular nodule
Case 89	54 year old female with an enlarging left thyroid nodule with FNA two months prior showing a follicular neoplasm • Hurthle cell type	Si787	Follicular adenoma • oncocytic (Hurthle cell) type (2.5 cm).
Case 90	80 year old female with an aggressive thyroid lesion infiltrating the neck requiring carotid stent	Si787	PTC • columnar cell variant with oncocytic features
Case 91	70 year old male with thyroid cancer	Si787	Undifferentiated (anaplastic) thyroid carcinoma (atleast 10.5 cm)
Case 92	31 year old female with Graves disease for definitive tx.	Si787	Papillary thyroid microcarcinoma (0.5 cm) with oncocytic and infiltrative features. Florid nodular papillary hyperplasia c/w Graves disease
Case 93	56 year old female with left paramidline neck mass	Si787	c/w thyroglossal duct cyst with evidence of infection and cyst rupture
Case 94	50 year old male with lump in left side of neck 4 months prior with FNA. PTC	Si787	PTC • tall cell variant (8 cm) met to LN with extrathyroidal extension. 2 months later - neck dissection showed undifferentiated carcinoma (S12-41329) and the patient died 6 months later
Case 95	34 year old male who noticed mass I his neck slowly growing over 4 years	Si787	Undifferentiated (anaplastic) thyroid carcinoma (10.5 cm) arising in association with poorly differentiated carcinoma (RVL - 10/2007)
Case 96	64 year old male presents with stridor and tracheal stenosis discovered to have a thyroid mass	Si787	PTC • classical variant with extrathyroidal extension • lymph node mets and parathyroid invasion
Case 97	57 year old man with Hashimoto disease. R/O alternative process	Si787	Fibrosing variant of Hashimoto thyroiditis with 23 IgG4 cells/hpf • IgG4/IgG less than 10% not diagnostic of chronic sclerosing thyroiditis
Case 98	66 year old male with left thyroid mass	Si787	Widely invasive follicular thyroid carcinoma • oncocytic (Hurthle cell) type • 12.5 cm. + LVI (ext) • + extrathyroidal extension • high grade features (necrosis)
Case 99	24 year old female with left sided thyroid nodule noted on clinical exam	Si787	PTC • solid variant (3.0 cm) with increased mits • ? Necrosis • no invasion
Case 100	37 year old female with 1.3 cm L thyroid mass	Si787	PTC • Warthin tumor-like variant
Case 101	86 year old male with a 4 cm L thyroid mass	Si787	Widely invasive Hurthle cell carcinoma
Case 102	42 year old male with thyroid cancer	Si787	PTC • classical type • multifocal with one nodule with features of hobnail variant • the other tall cell. BRAFVE +
Case 103	42 year old male with thyroid cancer	Si787	PTC • classical type • multifocal with one nodule with features of hobnail variant • the other tall cell. BRAFVE +
Case 104	65 year old female with left-sided thyroid nodule	Si787	Medullary thyroid carcinma (1.7 cm)
Case 105	33 year old female with two thyroid lesions • one with BRAF p.V600E (B6) • one with CCDC6::RET fusion product (B2)	Si787	Classic papillary thyroid carcinoma • two foci • one with BRAF p. V600E and one with CCDC6::RET fusion
Case 106	56 year old with hemorrhagic 6 cm thyroid nodule	Si787	Epithelioid angiosarcoma
Case 107	70 year old female with history of PTC	Si787	Undifferentiated (anaplastic) thyroid carcinoma (3.2 cm) with extensive squamous differentiation
Case 108	31 year old female with non-toxic thyroid	Si787	Dyshormonogenetic goiter (24 g)
Case 109	38 year old female with parathyroid enlargement	Si787	Parathyroid carcinoma (1.2 cm) tumor infiltrates thyroid and SSF vascular invasion
Case 110	52 year old male presents with kidney stones and elevated PTH	Si787	Atypical parathyroid adenoma (2.0 cm)
Case 111	55 year old female with ↑ PTH (90-100)-nl 10-60' • normal renal function • osteoporosis • 2 ↑ parathyroids on u/s and one gland with gestamibi uptake	Si787	Medullary adenoma (0.6 gm • 1.2 cm). One (1) normocellular gland 60 mg
Case 112	69 year old female with left inferior paratracheal mass and history of adrenal disease on spironolactone with elevated PTH and clcium	Si787	Enlarged (3.4 g) hyperplastic parathyroid with rare peripheral stromal fat. Possible water clear cell adenoma
Case 113	42 year old female with Alport syndrome (mut coll IV) s/p 2 failed kidney transplants with ESRD	Si787	Multigland parathyroid hyperplasia c/w secondary hyperparathyroidism
Case 114	44 year old male s/p kidney transplant for IgA nephropathy pending 2nd tx with morbid obesity (5'10" • 300 lb)	Si787	Nodular hyperplasia X 4 glands ? Tertiary hyperparathyroidism
Case 115	38 year old female with hyperparathyroidism	Si787	Atypical parathyroid adenoma (2.2 gm)
Case 116	30 year old woman with hyperparathyroidism	Si787	Parathyroid adenoma
Case 117	66 year old male with 21 gram R mediastinal mass (4.7 cm)	Si787	Parathyroid lipoadenoma (4.7 cm) negative for malignancy
Case 118	71 year old female with hyperparathyroidism	Si787	Atypical parathyroid adenoma (1.8 cm) at least partly intrathyroidal
Case 119	44 year old male with enlarged R parathyroid with 117 PTH	Si787	Atypical parathyroid adenoma (5.2 g) parafibromin retained. No overt features of malignancy
Case 120	55 year old female with primary hyperparathyroidism	Si787	Parathyroid adenoma with nodular fasciitis-like change
Case 121	59 year old male with (B) Thyroid nodules	Aja51	Papillary thyroid microcarcinoma one BRAF + classical 2 BRAF - FV
Case 122	31 year old woman with a right-sided 2.3 cm adrenal mass.	Pms36	Aldosteronoma (2.3 cm) • positive for CYP11B2 with additional aldosterone producing centers. Reticular stain shows a retained reticulin network without disruption.
Case 123	49 year old female with an incidental ~4 cm left adrenal mass noted on CT for r/o PE.	Emw8	Pheochromocytoma (4.2 cm) with prominent stromal hyalinization.
Case 124	50 year old male with adrenal excision in 2008 (A) and follow up "suprarenal" mass excision in 2010 (B).	Emw8	Adrenal cortical neoplasm (A). Consistent with metastatic adrenal cortical carcinoma (B). Tumor cells are positive for inhibin Melan A • and synaptophysin and negative for chromogranin • renal cell carcinoma antigen • carbonic anhydrase and PAX8.
Case 125	54 year old female with Cushing syndrome for several months and 11 cm left adrenal mass.	Emw8	Adrenal cortical carcinoma (13.5 cm) + LVI Mits 11:20 hpf
Case 126	71 year old female with Cushing syndrome and 13.0 cm left adrenal mass.	Emw8	Myxoid adrenal cortical carcinoma (13.0 cm) with largely tubular growth. + LVI 8:50 hpf Focal tumor necrosis.
Case 127	52 year old with right adrenal mass.	Emw8	Adrenal cortical adenoma (4.2 cm) adjacent adrenal with nodular cortical changes • regenerative changes versus nodular hyperplasia. Clinical correlation is needed.
Case 128	44 year old female with right adrenal mass.	Emw8	Adrenal cortical adenoma (4.0 cm).
Case 130	54 year old male with HTN and hypokalemia with elevated serum aldosterone (30) and aldo/renin = 6.5/0.6	Emw8	38 g adrenal cortical adenoma (0.8 cm).
Case 131	76 year old male who presents with 2-3 episodes of syncope associated sweating • elevated catecholamines and a 2.5 cm right adrenal mass.	Emw8	Pheochromocytoma (3.6 cm)
Case 132	52 year old female with relevant medical history; now with right adrenal mass.	Emw8	Metastatic melanoma • 2.1 cm.
Case 133	42 year old male with left adrenal mass • cystic lesion.	Emw8	Mesothelial inclusion cyst (3.2 cm). There is no evidence of neoplasia.
Case 135	66 year old male with right adrenal mass • rib lesion and elevated PSA.	Emw8	Malignant pheochromocytoma (12.0 cm) met to rib. Grade 6 prostate cancer • minimal.
Case 136	17 year old male with para-aortic tumor.	Emw8	Paraganglioma (2.5 cm) with loss of SDHB suggestive of SDHB mutation.
Case 138	27 year old female with h/o adrenal pheochromocytoma in 1999 • lung paraganglioma in 2003 and right ear paraganglioma in 2005. Now presents with carotid body tumor.	Emw8	Paraganglioma (carotid body tumor) 2.8 cm • in aggregate; LVI is noted.
Case 139	27 year old female with right adrenal mass.	Emw8	Atypical pheochromocytoma (7.0 cm) Increased vascular invasion Increased atypical mitoses + SDHB stain (intact).
Case 141	28 year old male with 1 year history of 14 cm left adrenal tumor s/p excision.	Emw8	Metastatic pheochromocytoma to lung tumor shows retained SDHB.
Case 142	23 year old female with 19 g left adrenal and 2.5 cm mass.	Emw8	Oncocytic adrenal cortical adenoma with myelolipomatous changes • periadrenal.
Case 143	58 year old female with (B) adrenal masses. (R) adrenalectomy.	Emw8	Adrenal cortical adenoma (4.0 cm). B-catinin intact. Ki67 <1%
Case 144	53 year old female with left adrenal mass and relevant clinical history.	Emw8	Metastatic melanoma (4 cm).
Case 145	51 year old male with incidental 5.0 cm left adrenal nodule with no symptoms.	Emw8	Atypical adrenal cortical neoplasm (5.2 cm) with marked endocrine nuclear atypia. No overt features of malignancy.
Case 147	70 year old male with end stage kidney disease and hypertension with aldosterone/renin levels suggestive of aldosteronoma.	Emw8	Adrenal cortical adenoma (1.2 cm) c/w aldosteronoma with spironolactone bodies secondary to prior treatment.
Case 150	43 year old male with malaise • nausea and diarrhea with a 5 cm lobulated left adrenal mass.	Emw8	Ganglioneuroma likely producing VIP.
Case 154	36 year old female with right lower quadrant pain underwent CT for r/o appendicitis has a 4.9 cm left retroperitoneal lesion abutting but not necessarily emanating from the adrenal gland.	Emw8	11.1 gm ganglioneuroma (6.5 cm) • extraadrenal.
Case 155	41 year old female with history of pituitary tumor and now with right-sided adrenal mass compatible with pheochromocytoma also elevated PTH . Father with renal cell carcinoma.	Emw8	Atypical pheochromocytoma (3.7 cm). Dark nests of cells suspicious for vascular invasion. SDHB -
Case 160	50 year old female presented with supraclavicular fullness and plethora found to have Cushing syndrome. Left adrenal mass.	Emw8	Adrenal cortical adenoma • 2.9 cm.
Case 164	42 year old male with Cushing syndrome and bilateral adrenal nodular hyperplasia.	Emw8	Nodular adrenal cortical hyperplasia. R - 132 g L - 142 g
Case 169	47 year old male with recurrent left renal cell carcinoma and a left adrenal mass.	Emw8	Metastatic renal cell carcinoma • clear cell type • to the adrenal.
Case 175	48 year old female with left adrenal nodule • 3.1 cm • noted on CT 4 years prior for unrelated reason. Recently presents to ED with abdominal pain. CT reveals adrenal mass is now 4.7 cm. Endocrine markers are negative.	Emw8	Adrenal cortical adenoma (5.0 cm). B-catenin with mixed nuclear and cytoplasmic staining. Mutational analysis required if + for mutation • 20% benign • 80% malignant. Close clinical follow-up. CTNNB p. S45P.
Case 177	53 year old female with left adrenal mass.	Emw8	Adrenal cortical adenoma (9.5 cm). Ki67 1-2% + nuclear B-catenin
Case 179	41 year old Asian male with 3 year history of HTN treated with lisinopril. RUQ pain 3 months prior to surgery. B. Adrenal masses.	Emw8	Macronodular adrenal cortical hyperplasia with a 3.8 cm left dominant nodule.
Case 182	52 year old male with left adrenal tumor.	Emw8	Malignant composite pheochromocytoma. 25% pheo and 75% ganglioneuroblastoma.
Case 186	43 year old male with left adrenal mass.	Emw8	Adrenal cortical carcinoma.
Case 191	41 year old with left adrenal mass.	Emw8	Adrenal cortical carcinoma (7.9 cm). 230g excision. mits 14:10 hpf + LVI + B-catenin mutation
Case 197	63 year old female with 24 cm left adrenal mass.	Emw8	Adrenal cortical carcinoma (24 cm). + LVI 5:50 hpf Ki67 1-2%
Case 204	53 year old male with right renal mass and adrenal mass.	Emw8	Adrenal gland: nodular hyperplasia. Kidney: RCC • clear cell type. VHL dx @ 16 yr
Case 205	61 year old male s/p left flank blunt trauma with adrenal hematoma 10 months prior.	Emw8	171g adrenal cortical carcinoma (7.5 gm)
Case 207	55 year old male with left adrenal mass.	Emw8	Pheochromocytoma (38.7 g) 1.9 cm decreased SDHB
Case 210	74 year old female with left adrenal mass.	Emw8	Adrenal cortical adenoma (3.2 cm) with central hemorrhage and organizing thrombus. Multiple myelipomatous change.
Case 214	66 year old female with Cushing Syndrome.	Emw8	Left and right diffuse nodular adrenal cortical hyperplasia c/w ACTH-dependent disease.
Case 219	56 year old female with right adrenal lesion(s).	Emw8	Pheochromocytoma (5.5 cm) extra-adrenal paraganglioma (2.3 cm) neurofibromas up to 0.5 cm.
Case 225	48 year old female with a left adrenal mass (37g adrenalectomy).	Emw8	Pheochromocytoma • two foci (3.0 and 2.5 cm) SDH retained. Focal bizarre endocrine atypia. Close follow-up recommended.
Case 232	69 year old male with adrenal gland resection.	Emw8	Adrenal cortical adenoma.
Case 233	55 year old female with right adrenal mass.	Emw8	Composite pheochromocytoma - ganglioneuroma (2.5 cm) completely excised. SDHB retained.
Case 234	59 year old male with left adrenal lesion.	Emw8	Nodular adrenal cortical hyperplasia with a dominant (2.8 cm) nodule.
Case 235	27 year old male who presents with marked hypertension and a pre-op visit for wisdom tooth extraction (220/120) and >10 cm left adrenal mass.	Emw8	Malignant pheochromocytoma • 800 gm • 14 cm with invasion of adrenal vein with large tumor thrombus.
Case 237	33 year old female with h/o MEN1 syndrome with concurrent well-differentiated pancreatic neuroendocrine tumor • grade 1 • with ductules of the pancreatic tail; also with 43g left adrenalectomy for 4.2 cm mass.	Emw8	Atypical myxoid adrenal cortical neoplasm with adjacent nodule adrenal cortical change. Medulla unremarkable. Mits 7:50 hpf. Ki67 11.4%. 1. >5% 150 hpf. 2. high Fuhrman grade. 3. <25% clear cells. → low grade myxoid adrenal cortical carcinoma
Case 240	79 year old female with retroperitoneal mass. mits 3/10 hpf	Emw8	Paraganglioma • worrisome for malignancy.
Case 244	50 year old male with nodular bilateral adrenal enlargement.	Emw8	Marked adrenal cortical nodular hyperplasia with an expanded medulla.
Case 245	44 year old obese man with congenital adrenal hyperplasia with massive left sided adrenal compressing the spleen and stomach.	Emw8	Myelolipoma (20.5 cm) arising in association with multinodular eosinophilic adrenal cortical hyperplasia.
Case 246	75 year old female with multiple hemangiomas and large adrenal mass.	Emw8	Angiosarcoma • grade 2/3 arising within an adrenal cortical adenoma (11 cm) with lipomatous metaplasia.
Case 248	51 year old woman with growing cystic left adrenal lesion (22 gm).	Emw8	Cystic follicular thyroid lesion (3.3 cm) (benign).
Case 251	71 year old female with left adrenal mass.	Emw8	Adrenal cortical nodular hyperplasia with a dominant 3.0 cm adenomatous nodule.
Case 255	12 year old male with 5 cm adrenal mass.	Emw8	Ganglioneuroma (4.7 cm) adjacent to uninvolved adrenal gland.
Case 260	53 year old male with left adrenal mass and concurrent lung lesion.	Emw8	Metastatic poorly differentiated carcinoma c/w lung primary.
Case 266	48 year old female with episodic pain X 12 years of RLQ and multiple paraaortic • paracaval and intrahepatic nodules. Here • retroperitoneal tumor.	Emw8	Malignant paraganglioma • multifocal.
Case 267	1 year old female with 15 watery stools qd.	Emw8	Ganglioneuroma secreting VIP.
Case 269	54 year old woman with history of papillary thyroid cancer • hyperparathyroidism and Cushing syndrome with a 2.5 cm left adrenal mass.	Emw8	Adrenal cortical adenoma (3.0 cm). Eosinophilic • lipofuscin pigment • lipomatous metaplasia c/w cortisol-producing adenoma.
Case 272	49 year old female with CT abdomen/pelvis and cystoscopy for microscopic hematuria with incidental adrenal mass (3.4 cm) with normal adrenal hormone levels.	Emw8	Adrenal cortical oncocytoma (4.0 cm)
Case 276	47 year old female with 7 year history of "burning in chest and throughout body".	Emw8	Pheochromocytoma (3.9 cm) with normal adjacent adrenal.
Case 281	25 year old female with HTN X 5 years and right adrenal mass.	Emw8	Adrenal cortical adenoma (2.7 cm)
Case 282	55 year old male with abdominal pain and CT scan revealed a "huge" LUQ mass.	Emw8	Adrenal pseudocyst (16.0 cm). No overt features of malignancy.
Case 284	48 year old female with tuberous sclerosis and bilateral angiomyolipomatous kidneys • now with large right superior pole kidney mass.	Emw8	Adrenal cortical carcinoma • 6.1 cm.
Case 287	48 year old female transferred with MI • worsening episodic headache • tachycardia and palpitations. MR → 6 cm left adrenal mass.	Emw8	Pheochromocytoma (6.0 cm).
Case 291	41 year old male with acute left flank pain. CT shows left adrenal mass.	Emw8	Myelolipoma (9.5 cm).
Case 296	56 year old woman with leg swelling and weight gain.	Emw8	Macronodular hyperplasia with marked adrenal enlargement (110 gm) with 5.5 cm dominant nodule • extension into periadrenal adipose tissue • myelolipomatous and lipomatous metaplasia • always bilateral • often delay (in years) of bilateral presentation. ACTH-independent.
Case 302	56 year old male with MENZA • bilateral adrenal lesions and a liver lesion.	Emw8	Bilateral pheo (0.5 cm) with cortical and medullary hyperplasia. Metastatic medullary thyroid carcinoma to liver (prior thyroidectomy)
Case 309	25 year old female with HTN x 5 years and a 2.7 cm right adrenal mass found on imaging.	Emw8	Adrenal cortical adenoma (2.7 cm).
Case 317	41 year old female • pregnant • with severe HTN • headaches and pre-eclampsia → MR 4 cm left adrenal mass.	Emw8	Pheochromocytoma (4.2 cm)
Case 326	65 year old female with hypothyroidism with neck tenderness December 2009 • hard right-side neck nodule with FNA+ PTC.	Emw8	Undifferentiated (anaplastic) thyroid carcinoma arising in association with papillary thyroid carcinoma • hobnail variant (4.5 cm).