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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. Differential diagnosis Phaeochromocytoma, adrenal cortical tumour, Cushing's syndrome, adrenal metastasis. Treatment 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 Erlotinib cell line examination. Outcome and follow-up The patient is doing well after 3?months follow-up. Discussion IMT is a relatively rare neoplasm. It was previously referred as plasma cell granuloma. IMT was first observed by Brunn in 1939. It was later termed inflammatory pseudotumour by Umiker and Iverson in 1954. It has long been debated regarding the origin of IMT, whether it was truly neoplastic or a postinflammatory process. IMT is usually seen in the lung, followed by the orbit.5 In the genitourinary tract, it most commonly occurs in the bladder. However, it rarely originates in the kidney, renal pelvis and ureter. Only two cases of adrenal IMT have been reported so far. Commonly seen in childhood or in adults, these tumours are considered benign. It has been described in almost any location, in both sexes and at all ages. They are usually asymptomatic; they rarely have symptoms like loss of weight, fever, decreased appetite and other vague symptoms. Similarly, our patient presented with dull flank ache without any associated symptoms. On imaging, ultrasonography shows a variable pattern of echogenicity, and the lesion has been described as hypoechogenic or hyperechogenic with ill-defined or well-defined margins.6 CECT may show homogeneity or heterogeneity and hypodensity, isodensity or hyperdensity.7 IMT of the urinary tract is extremely difficult to distinguish from malignant tumours. In this patient, the CECT of abdomen disclosed findings of heterogeneous hypodense mass in left adrenal, which were non-specific. Grossly, IMTs may be firm, fleshy or gelatinous, with a white or tan cut surface. Calcification, haemorrhage and necrosis are identified in a minority of cases. Tumours range from 1 to 20?cm in greatest dimension, with a mean size of 6?cm. The histological differential diagnosis of IMT depends in part on the dominant pattern: myxoid/vascular, compact spindle cell or fibromatosis-like. It is characterised on the basis of electron microscopic and immunohistochemical findings.