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[http://www.selleck.co.jp/products/AP24534.html Ponatinib order] Family history was not suggestive of either multiple endocrine neoplasia syndrome, neurofibromatosis 1,Von Hippel-Lindau disease or familial pheochromocytoma/paraganglioma syndrome. Physical examination was essentially normal. His serum biochemical parameters for adrenal mass work-up were normal.  The 24?h urinary catecholamines like metanephrine, normetanephrine and vanillylmandelic acid were within normal limits. Ultrasound abdomen revealed a 6?cm��6?cm hypoechoic mass occupying the left suprarenal region. Contrast enhanced CT (CECT) showed a well-defined heterogeneous hypodense lesion of size 6.8?cm?��?7?cm��5.5?cm with mild non-uniform arterial, porto-venous and delayed-phase enhancement while no evidence of haemorrhage/calcification was seen, involving the left adrenal gland (figure 1A,B). The mass had replaced the left adrenal gland. The opposite gland was normal and there was no evidence of any other mass lesion in the abdomen. Figure?1 (A) Contrast enhanced CT (CECT) axial images showing a 6.8?cm��7?cm��5.5?cm well-defined heterogeneous hypodense lesion in the left adrenal gland. (B) CECT coronal images showing a 6.8?cm��7?cm��5.5?cm ... The patient was planned for exploration, with preoperative preparation  for any intraoperative haemodynamic changes. Under general anaesthesia, in the left flank position, the transperitoneal approach through the bed of the 11th rib, exploration revealed a 7?cm��6?cm encapsulated tumour of the left adrenal gland was found displacing the left renal vein. A complete surgical extirpation of the tumour was performed. There were no changes in the haemodynamic status during and after the resection of  tumour. The postoperative course was uneventful. The excised specimen was sent for histopathological examination. On gross examination, an encapsulated greyish brown mass measuring 6.5��6?��?5?cm with cut section showing pale yellow myxoid areas and peripherally compressed adrenal gland was seen. Histopathological study showed an encapsulated tumour composed of elongated spindle-shaped cells with vesicular elongate, indented nucleus and abundant eosinophilic cytoplasm arranged in focal fascicles and in singles suspended in abundant myxoid stroma with interspread thin and thick walled blood vessels, scattered ganglion-like cells admixed with lymphocytes, plasma cells, eosinophils and few neutrophils (figure 2A,B). The features were suggestive of adrenal IMT. Figure?2 (A) Section shows elongated spindle-shaped cells suspended in abundant myxoid stroma with a sprinkling of lymphocytes. H&E, ��200 (B).Scattered ganglion-like rounded cells with enlarged nucleus seen. H&E, ��400. Investigations Ultrasound of the abdomen revealed a 6?cm��6?cm hypoechoic mass occupying the left suprarenal region. CECT showed a well-defined heterogeneous hypodense lesion of size 6.8?cm?��?7?cm��5.