Table 2.
Definitive pathology examination and immunohistochemistry.
| References | Macroscopic | Cell Morphological Characteristics | Mitotic Activity | Immunohistochemistry |
|---|---|---|---|---|
| CHOI SH, J Surg Oncol 1981 [10] | Central area of cystic degeneration and necrosis | spindle-shaped cells arranged in bundles atypia with nuclear hyperchromatism. | evident | - |
| LACK EE, Am J Surg Pathol 1991 [11] | Necrotic and hemorrhagic area of neoplasm | spindle cells having elongated, blunt-ended nuclei and tapering, eosinophilic cytoplasmic processes | 15 per 10 high power fields of mitotic figures | Vimentin ab +; S-100 protein −/+; HHF-35 +; α-SMA +. |
| ZETLER PJ, Arch Pathol Lab Med 1995 [12] | - | - | - | SMA + |
| BOMAN F, Arch Pathol Lab Med 1997 [13] | - | - | - | - |
| - | - | - | - | |
| ETTEN B, Sarcoma 2001 [14] | areas of coagulation necrosis | spindle cell tumor with a moderate degree of atypia |
up to 10 mitoses per 2 mm2 | strong immunoreactivity for α-SMA |
| MATSUI Y, Int J Urol 2002 [15] | central area of cystic degeneration | interlacing fascicles of spindle cells | many mitoses | cytoplasmic (SMA) immunoreactivity |
| LUJAN MG, Arch Pathol Lab Med 2003 [16] | hemorrhagic, multinodular mass with irregular zones of necrosis | pleomorphic neoplastic cells | Ki-67 about 80% | |
| THAMBOO TP, Pathology 2003 [17] | ||||
| LINOS D, Surgery 2004 [18] | fibrous substrate, with inflammatory areas | characteristic spindle-shaped neoplastic cells | - | Positive for smooth muscle actin, vimentin, and actin HHF Negative for S100, CD 34, desmin, and ALK. |
| KATO K, Int J Clin Oncol 2004 [19] | areas of hemorrhage and necrosis |
spindle-shaped cells with a fibrillary appearance |
several mitotic figures | Positive for SMA, desmin and vimentin. Negative for neuron-specific enolase (NSE), S-100, chromogranin, synaptophysin, and CD34 |
| WONG, J R Soc Med 2005 [20] | - | - | - | - |
| CANDANEDO-GONZALEZ FA, Endocr Pathol 2005 [21] | a circumscribed, solid, multinodular, green-red mass, with markedly necrotic and hemorrhagic areas, and extra adrenal extension 2400 g |
hypercellular areas, with a diffuse proliferation of pleomorphic neoplastic cells and osteoclast-like giant cells |
15 mitotic figures per 10 high power fields, Ki-67 was 7.6% | Positive for SMA, desmin vimentin and p53, Tumor cells were negative for CD34, HMB45, estrogen receptors, and S-100 protein. |
| LEE CU, Abdom Imaging 2006 [22] | - | hypercellular tumor with a haphazard arrangement of spindled, oval, or rounded cells intermingled with bizarre tumor cells |
- | positive for desmin and negative for creatine kinase, myoglobin, S-100, CD34, CD117 (Ckit), and HMB-45 |
| MOHANTY SK, Urology 2007 [23] | It was almost completely replaced by a centrally hemorrhagic and partially necrotic rubbery to firm mass 180 g |
neoplastic cells were spindled to plump, with cigar-shaped blunt-ended nuclei. In areas, the tumor showed moderate-to-marked nuclear pleomorphism and conspicuous nucleoli. | brisk mitotic activity (12–14/HPFs) ki67 was > 75% |
strong immunoreactivity for muscle markers (desmin, calponin, and actin), whereas those for cytokeratins (pankeratin, AE1/AE2), renal cell markers (RCC, CD10), melanoma markers (S100, melan A), and adrenal markers (Inhibin, melan A) were negative |
| WANG TS, World J Surg Oncol 2007 [24] | a firm, nodular and trabeculated tan-white mass with focal areas of cystic degeneration and hemorrhage Areas of coagulative necrosis were present |
composed of spindle cells arranged in intersecting fascicles. Tumor cells showed moderate atypia with hyperchromasia, nuclear enlargement and occasional giant cells. |
three to five mitoses per 10 high power fields were identified, with occasional atypical mitotic figures |
strong reactivity for desmin and smooth muscle actin; negative for c-kit, S100 and HMB45 |
| GOTO J, Endocr J 2008 [25] | White rubbery tissue with central degeneration due to necrosis and hemorrhage | Fascicles of spindle cells | Mitotic rate as high as 2–5 cells/high power field (HPF) | Positive for SMA; CD57, S-100 and CD117 were negative, the composed cells were massively positive with NSE protein |
| MENCOBONI M, Clin Med Oncol 2008 [26] | A roundish, fibrous neoformation with a thrombus inside the adrenal vein | Elongated cells with eosinophilic cytoplasm and elongated nuclei with rounded and small nucleolus with moderate polymorphism, arranged in fascicles, no necrotic areas | 16/50 HPF mitotes Ki67 20% |
Positive for desmin, SMA(1A4), Actin (HHF3, HHF35, Primary Antibody 5); CD34, CD117 were negative. |
| VAN LAARHOVEN HV, Anticancer Res 2009 [27] | - | - | - | - |
| HAMADA S, Int J Clin Oncol 2009 [28] | - | Spindle- shaped neoplastic cells | Strong staining of SMA, but negative staining for keratin, CD34 e c-kit | |
| KARAOSMANOGLU A, J Ultrasound Med 2010 [29] | Spindle cells sarcoma with smooth muscle differentiation consistent with high grade leiomyosarcoma | Diffuse staining for actin and vimentin and patchy staining for desmin and keratin | ||
| SHAO IH, Chang Gung Med J 2012 [30] | Spindle cells tumor, composed of interlacing fascicles of neoplastic smooth muscle cells | Positive for desmin and SMA, negative for CD117, HMB45, CD34. | ||
| KANTHAN R, World J Surg Oncol 2012 [31] | Ragged, irregular, pale rubbery multinodular mass with hemorrhage and necrosis 1492 g |
Tumor cells arranged in sheets and storiform patterns with extensive fibrous spindled stroma in some areas and others with a myxoid background | Ki67 and p53 moderately expressed | Strongly positive with SMA and vimentin, negative staining to pan-keratin, CK7, CK20 and HMWK. Negative staining with myogenin and desmin, S-100 was negative too. |
| DESHMUKH SD, J Cancer Res Ther 2013 [32] | Uniform, grey-white color with streaks and strands and a whorled appearance in places; no areas of hemorrhage and necrosis | Spindled neoplastic cells, arranging in interlacing bundles and fascicles of varying sizes. | 10 to 12 abnormal mitotic figures per 10 HPFs | Strong reactivity for SMA, desmin and vimentin; negative for CK, S-100 protein, CD117, HMB45 and CD34 |
| GULPINAR MT, Case Rep Urol 2014 [33] | Roundish fibrose neoplasia, yellow-creamy-white solid mass with a central necrotic area. 370 g |
Spindle cells associated with predominantly diffuse plasma cell infiltration prevalent in the necrotic areas | Ki67 was 4% | Strongly diffuses vimentin, moderately diffuses SMA; negative for pan-cytokeratin, inhibin, synaptofisin, chromogranin, CD30-31-34-117, S-100, ALK, myogenin, lambda an k light chain proteins immunonegative |
| OZTURC H, Rare Tumors 2014 [34] | Cystic features and bleeding at focal point, no necrosis | Cells with spindle-shaped nuclei and pink cytoplasm that crossed each other at varying angles and pleomorphism at certain foci | 8–10/10 HPFs, ki67 was 70% | SMA, desmin positive; CK and bcl2 negative |
| LEE S, Korean J Pathol 2014 [35] | Enlarged lobulate mass of 792 g, well sub-circumscribed and partially encapsulated tumors | Spindle cells tumor with a rim of fibrous tissue with entrapped atrophic adrenal cortical cells, geographic coagulation necrosis with surrounding fibrosis | 25/10 HPFs | Strongly positive for SMA and desmin; pan cytokeratin, CD117, S-100 protein and HMB45 were all negative |
| BHALLA A, Conn Med 2014 [36] | Atypical spindle-shaped cells arranged in intersecting fascicles. Focal tumor necrosis |
High mitotic activity | SMA and desmin were positive, S-100 and c-kit were negative | |
| WEI J, Int J Surg Pathol 2014 [37] | Firm, grayish white mass surrounded by a fibrous pseudo capsule, with focal areas of hemorrhage | Large area of necrosis, neoplastic cells arranged in interlacing fascicles; in some areas it ranged from spindled to plump with cigar-shaped, blunt-ended nuclei | More than 10 abnormal mitotic figures per 50 HPFs | Strongly positive for SMA, desmin and vimentin; negative for cytokeratin, CD117, CD34, CD68, S-100, HMB45, myoglobin |
| MANZANO AJ, AACE Clin Case ReP 2015 [38] | A reconstructed mass with heterogeneous borders and areas of internal necrosis | Spindle cells neoplasia, atypical mitosis and necrosis | Ki67 focally greater than 50%, present in 40% of proliferating cells | Positive for SMA, desmin and focal myogenin (MYF4); S-100 and inhibin were negative |
| NAGARAJ V, Case Rep Surg 2015 [39] | Grossly, multiple pieces of grayish white friable tissue with attached small amount of fatty tissue, with mucoidal areas and tiny hemorrhagic areas. 1040 g | High-grade spindle cells with eosinophilic cytoplasm and spindly, blunt ended vesicular nuclei | - | Strongly positive for desmin and vimentin; negative for calretinin, inhibin, chromogranin, synaptophysin, S-100 pankeratin and CD68. |
| ZHOU Y, Int J Clin Exp Pathol 2015 [40] | Roundish, grayish white mass, with areas of hemorrhage and necrosis | Hypercellular tumor, intersecting fascicles of spindle cells | Ki67 > 60% | Positive for desmin, SMA, vimentin and negative for CD34, S100, CD117, bcl2 and Dog1. |
| PEREIRA-BECEIRO J, Cir Esp 2015 [5] | ||||
| QUILDRIAN S, Endocrinol Nutr. 2015 [41] | - | Interlacing fascicles of spindle cells with elongated hyperchromatic nuclei and marked pleomorphism | Ki67 was 20%, with up to 12 mitoses/10 HPFs | Strongly positive for vimentin (80%), H caldhemon (90%), SMA (70%), desmin (10%), actin HHF-35 (80%), CD34 (60%); CD117-68, S100, cytokeratin AE1 AE3 were negative. |
| ONISHI T, World J Surg Oncol. 2016 [42] | Solid and grayish white mass with some mucoid and small necrotic areas | Spindle-shaped cells with eosinophilic cytoplasm and pleomorphic nuclei | Ki67 approximately 50% in the hot spot | Diffusely positive for SMA and negative for S100 and CD34 |
| LI C-C, Urol Sci. 2016 [43] | - | - | 18/10 HPFs | Positive for SMA, desmin, H caldesmon; negative for S100, CD34 |
| RUDIN A, Clin Surg. 2016 [44] | White lobulated fleshy area that focally grew into the lumen of the adrenal vein, red and hemorrhagic soft area | Intersecting fascicles of spindle cells with atypical cigar-shaped nuclei and abundant eosinophilic cytoplasm, not necrosis area | Scattered mitotic figures were present | Strongly positive for SMA; negative for desmin, HMB45, MITF, inhibin |
| AOKI C, J Clin Case Rep 2017 [45] | - | Atypical spindle cells with oval-shaped nuclei growing in a flowing sequence | - | Positive SMA and vimentin; |
| TZAIDA O, Ann Clin Exp Metabol 2017 [46] | Thin fibrous pseudo capsule, with areas of hemorrhage and necrosis areas | Interlacing fascicles of glycogen-rich (PAS-positive), spindle-shaped cells with moderate nuclear pleiomorphism. | Ki67 up to 30%; mitotic rate 7 to 8/10 HPFs | Positive for vimentin, actin, desmin, HHF35 and caldesmon; cytokeratin AE1 AE 3, HMB45, CD34, c-kit and S100 negative |
| MULANI SR, Case Rep Gastrointest Med 2018 [47] | - | Spindle cell neoplasm with extensive necrosis | High power view showing fascicular growth pattern and cytological pleomorphism. | Positive for desmin, cytokeratin Mak6, WT1, and S-100. Negative for CD34 and chromogranin |
| DOPPALAPUDI SK, BMJ Case Rep CP. 2019 [48] | Multilobular mass, without identified tissue plane | Hypercellular spindle cell neoplasm, cigar-shaped, running in parallel fascicles to one another, and demonstrated small, prominent nucleoli | - | Strong diffuse immunoreactivity to SMA and caldesmon |
| NERLI R, Int Cancer Confer J. 2020 [49] | Nodular, firm, well encapsulated tumor | Spindle-shaped tumor cells with prominent, eosinophilic cytoplasm resembling smooth muscle fibers | MIB 1/ki67 18–20% in the proliferative area of the tumor; nuclear mitosis increased | Positive for desmin and H caldesmon; ckit negative |
| SAKELLARIOU M, Mol Clin Oncol. 2020 [50] | Lobulated appearance, cystic degeneration, necrosis in cross section and residual adrenal tissue on outer tissue 594 g |
Spindle cell tumor with intermediate nuclear atypia and small areas of ischemic necrosis | 7 mitoses/10 HPFs; ki67 approximately 75% | Positive for desmin, SMA; negative for S100, synaptophysin, chromogranin, pan-cytokeratin, calretinin |
| LOKANATHA Indian J Med Paediatr Oncol. 2020 [51] | Encapsulated solid mass, roundish, with areas of hemorrhage | Spindle cell neoplasm | 5–6 mitosis/10 HPFs; ki67 was 40% | Positive for SMA, desmin, H caldesmon and CD34, negative for CD117, S100, DOG1 |
| Waack A, Radiol Case Rep. 2022 [1] | Well encapsulated adrenal mass with areas of necrosis | - | Increased of ki67 | Positive for SMA, desmin, calponin, caldesmon and vimentin; negative for S100, CD34, ckit |
| Our Case Rep | Solid neoplastic proliferation | Spindle cells arranged in a fascicular pattern with areas of coagulative necrosis and areas of hyalinization of the stroma | Frequent mitotic figures | Positivity for SMA, desmin and calponin; negativity for cytokeratin, S100, EMA |
α-SMA (alpha smooth muscle actin), HHF35 (muscle-actin-specific monoclonal antibody), HPFs (high power fields), HMWK (high molecular weight keratin), ALK (negative anaplastic lymphoma), (EMA) Epithelial Membrane Antigen.