Case of the Month: April 2023

Clinical history

A 31-year-old patient presented to the emergency room with a several-week history of headaches and recurrent episodes of palpitations, shortness of breath, anxiety, and sweating. Blood and urine tests were ordered and the patient was sent for imaging studies, which revealed a unilateral well-circumscribed lesion in the adrenal gland measuring 4.5 cm in maximum dimension. The patient was started on medications(s) and discharged from the hospital. A few weeks later the patient had surgery to remove the tumour.

How to participate

Take a look at the H&E images of this patient’s adrenal tumour.

Anyone is welcome to try to solve the puzzle by commenting on the related post on our Instagram.

If you are a medical student at the University of Toronto, you can also:

If you do, you are in for a chance to win a $100 gift card! (UofT Med students only).


Discover the answer to April's case of the month!

The answer to the April Case of the Month is Pheochromocytoma. Pheochromocytoma is a paraganglioma of the adrenal medulla composed of chromaffin cells that produce catecholamines, which are responsible for the symptoms patients experience. Tumour cells are typically large and polygonal with abundant finely granular cytoplasm and are arranged in a nested zellballen pattern outlined by sustentacular cells. Pre-surgical diagnosis is made by combination of symptoms, biochemical tests for metanephrines, and medical imaging. Treatment includes alpha blockade followed by surgery. All pheochromocytomas are considered to have malignant (metastatic) potential.

Although most pheochromocytomas are sporadic, 30-40% of cases are associated with genetic syndromes. These include Von Hippel-Lindau syndrome, MEN2a, MEN2b, Neurofibromatosis type 1, and hereditary paraganglioma-pheochromocytoma syndrome. Genetic testing is recommended for all patients with pheochromocytoma.

Stay tuned for the May Case of the Month, which will be posted mid-May! 

If you are a current medical student at U of T, you can register to join the April case of the month lecture online or in person and have a chance to win a $100 gift card!

If you’re a medical student at the University of Toronto interested in Laboratory Medicine join the Special Interest Group in Laboratory Medicine to be invited to a case of the month lecture (catered).

Laboratory Medicine and the study of disease for medical students

Medical students in the gross lab