Figure 1. The radiographical assessment of enhanced computed tomography and I123-metaiodobenzylguanidine scintigraphy findings.
Abdominal enhanced computed tomography showed that the right adrenal tumor surrounded by a yellow circle had grown to 4 cm in diameter (A: transverse plane, B: coronal plane). I123-metaiodobenzylguanidine scintigraphy showed no uptake (C: transverse plane).
Figure 2. Intraoperative findings, including the port layout for laparoscopic surgery andhistopathological findings.
The port layout at the operation showed a 12-mm port, mainly used as a camera port, and a 5-mm port, mainly used as a working port (A). It was important to keep the tumor as intact as possible, so we grasped the tissue surrounding the tumor (B). Blood vessels were cut using the vessel sealing system (C). Hematoxylin-eosin stain showed that the surgical specimen consisted of round cells with rich neurofibrils and <50% stroma of Schwann cells. The tumor cells had round nuclei and eosinophilic vesicles and large cells that prominently showed differentiation into ganglion cells (D). Immunohistochemical staining showed positive findings for VIP (E).