Adrenal Ewing's Sarcoma in an Elderly Man

Figures

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  Figure 1.. Imaging studies of the adrenal tumor before surgery (A-E) and recurrent liver tumors after surgery (F). A: Computed tomography studies demonstrated a large heterogeneous tumor in the right adrenal gland. B: An 18F-fluorodeoxyglucose-positron emission tomography image of the adrenal tumor showed the enhanced uptake of the tracer in the tumor. C: The tumor was hypointense on T1-weighted magnetic resonance imaging. D: T2-weighted magnetic resonance imaging showed that the internal signal was heterogeneous. E: Metaiodobenzylguanidine scintigraphy findings were negative. The position of the tumor is indicated by the yellow circle. F: 18F-fluorodeoxyglucose-positron emission tomography studies in December revealed multiple recurrence of the malignant tumor in the liver.

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  Figure 2.. Pathological findings of the resected primary tumor. A: Hematoxylin-Eosin staining shows tumor cells with round nuclei and pale cytoplasm and the formation of rosette structures (yellow circles) (×40 magnification). B: Immunohistochemistry revealed that the tumor cells were positive for CD99 (×20 magnification). C: Immunohistochemistry revealed that the tumor cells were positive for Nkx2.2 (×20 magnification). D: Separation of the red signal and green signal (arrows) by fluorescence in situ hybridization reveals Ewing’s sarcoma breakpoint region 1 gene rearrangement of the tumor cells, while the yellow signal (arrowhead) shows the normal allele.

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  Figure 3.. Autopsy studies. A: The right lobe of the liver had been mostly replaced by tumor tissue (yellow circle). B: The liver tumors contained CD99-positive cells (×20 magnification).