Figure 10d. AIMAH in a 50-year-old man with Cushing syndrome. (a) Contrast-enhanced CT scan shows massive hyperplasia of both adrenal glands (arrows), which still retain their adreniform contour. (b, c) Axial unenhanced (b) and contrast-enhanced (c) fat-saturated spin-echo T1-weighted MR images (500/16) show intense homogeneous enhancement of the hyperplastic nodular glands. (d, e) Axial in-phase (150/4.2) (d) and out-of-phase (150/2.3) (e) FMPSPGR T1-weighted MR images (flip angle = 90°) demonstrate 42% signal dropout within the glands with the out-of-phase sequence, a finding that indicates the presence of intracellular lipid. (f) Sectioned gross resected specimen of the left adrenal gland shows marked cortical expansion with multiple nodules (arrows). (g) Photomicrograph (original magnification, x200; H-E stain) reveals sheets of largely fascicular zone cells and areas of glomerular zone cells, which have a more compact trabecular pattern. No malignant or pigmented cells are seen.