Fig. 1

Radiological and histopathological characteristics in case 1. A-B An enhanced CT scan showing a 10 × 6 × 11 cm right-sided adrenal tumor with a normal adrenal gland (green arrow) on the dorsal side (A) and metastatic lesions in the lung (B). C T2-weighted MRI images showing lymphadenopathy in the hilum and para-aorta. D High signal in T1-weighted MRI images reveal venous thrombosis from the inferior vena cava to the right common iliac vein and the right internal iliac vein. E Hematoxylin eosin staining showing atypical spindle cells in adrenal biopsies (40 x). F-H Tumor cell staining positive for smooth muscle actin SMA (F 100 x), desmin (G 100 x) and vimentin (H 100 x). I Immunohistochemical staining of the cells with the Ki-67 marker (100 x). J EBV-encoded RNA in situ hybridization (EBER-ISH) staining for Epstein–Barr virus (EBV) was negative (100 x)