Figures
![Figure 1.](/tables/wjon760w-g001.jpg)
Figure 1. Right adrenal bed resection compatible with recurrent malignant pheochromocytomas. (A) × 100: microscopically, the tumor cells are arranged in well defined nests (“Zellballen”) bound by delicate fibrovascular stroma; (B) × 200: higher power shows amphophilic cytoplasm with a somewhat fibrillary cytoplasm.
![Figure 2.](/tables/wjon760w-g002.jpg)
Figure 2. Magnetic resonance imaging of the abdomen showing metastasis to right hip.
![Figure 3.](/tables/wjon760w-g003.jpg)
Figure 3. Magnetic resonance imaging of the abdomen showing (A) empty right adrenal and renal fossa and (B, C) metastasis seen in the vertebrae.
![Figure 4.](/tables/wjon760w-g004.jpg)
Figure 4. (A) Multilevel-multifocal osseous metastases particularly within thoracolumbar spine with slight epidural extension at T-7 and mild epidural disease at T-10 without cord compression. (B) Right retrocrural/paraspinal metastasis is seen at T-12 and L-1 level measuring about 1.5 cm.
![Figure 5.](/tables/wjon760w-g005.jpg)
Figure 5. Multiple predominantly osseous metastasis with metastasis in the right iliac bone, increased conspicuity of several soft tissue nodules in the right adrenalectomy bed consistent with recurrent neoplasm, a superior structure measuring 3.4 × 2.6 cm not well defined from adjacent unopacified liver is seen, the right diaphragmatic crus and the unopacified IVC and an adjacent posterior nodule measuring 3 × 1.6 cm is noted.
Table
Table 1. Pheochromocytoma of the Adrenal Gland Scoring Scale (PASS)
Nuclear hyperchromasia | 1 |
Profound nuclear pleomorphism | 1 |
Capsule invasion | 1 |
Vascular invasion | 1 |
Extension into adipose tissue | 2 |
Atypical mitotic figures | 2 |
Greater than 3 of 10 mitotic figures high-power field | 2 |
Tumor cell spindling | 2 |
Cellular monotony | 2 |
High cellularity | 2 |
Central or confluent tumor necrosis | 2 |
Large nests or diffuse growth (> 10% of tumor volume) | 2 |
Total | 20 |