Difference between revisions of "Adrenal gland"

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***Marked eosinophilia of cytoplasm - '''key feature'''.
***Marked eosinophilia of cytoplasm - '''key feature'''.
***Granular/reticular cytoplasm.
***Granular/reticular cytoplasm.
*Medulla - produces epinephrine
*Medulla - produces ''NED'': norepinephrine, epinephrine, dopamine.


==Benign==
==Benign==
*Spironolactone bodies<ref>{{cite journal |author=Kovacs K, Horvath E, Singer W |title=Fine structure and morphogenesis of spironolactone bodies in the zona glomerulosa of the human adrenal cortex |journal=J. Clin. Pathol. |volume=26 |issue=12 |pages=949-57 |year=1973 |month=December |pmid=4131694 |pmc=477936 |doi= |url=http://jcp.bmj.com/cgi/pmidlookup?view=long&pmid=4131694}}</ref>
*Spironolactone bodies.<ref>{{cite journal |author=Kovacs K, Horvath E, Singer W |title=Fine structure and morphogenesis of spironolactone bodies in the zona glomerulosa of the human adrenal cortex |journal=J. Clin. Pathol. |volume=26 |issue=12 |pages=949-57 |year=1973 |month=December |pmid=4131694 |pmc=477936 |doi= |url=http://jcp.bmj.com/cgi/pmidlookup?view=long&pmid=4131694}}</ref>
**location: zona glomerulosa (where aldosterone is produced)
**Location: zona glomerulosa (where aldosterone is produced).
**appearance: eosinophilic spherical laminated whorls.
**Appearance: eosinophilic spherical laminated whorls.
**etiology: long-term use of spironolactone.
**Etiology: long-term use of spironolactone.


==Adenomas==
==Adenomas==
Radiology<ref>URL: [http://emedicine.medscape.com/article/376240-overview http://emedicine.medscape.com/article/376240-overview].</ref>
Radiology<ref>URL: [http://emedicine.medscape.com/article/376240-overview http://emedicine.medscape.com/article/376240-overview].</ref>
*radiologists are good at identifying adenomas, as they are usually lipid rich and have a characteristic low HU signal.
*Radiologists are good at identifying adenomas, as they are usually lipid rich and have a characteristic low HU signal.


Treatment is excision if...<ref name=pmid10870039>PMID 10870039.</ref><ref name=pmid19035218>PMID 19035218.</ref>
Treatment is excision if...<ref name=pmid10870039>PMID 10870039.</ref><ref name=pmid19035218>PMID 19035218.</ref>
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Features:
Features:
*Architecture:
*Architecture:
**Cell nests, ''auf deutsch'': Zellballen (literally 'Cell balls').
**Cell nests, ''auf deutsch'': Zellballen (literally ''Cell balls'').
***Useful for differentiating from ACC.
***Useful for differentiating from ACC.
*Nuclei.
*Nuclei.
Line 88: Line 88:
==Ganglioneuroma==
==Ganglioneuroma==
Micro.<ref>[need ref]</ref>
Micro.<ref>[need ref]</ref>
*disordered fibrinous material
*Disordered fibrinous material
*ganglion cells.
*Ganglion cells.
**large cells with large nucleus.
**Large cells with large nucleus.
***prominent nucleolus.
***Prominent nucleolus.


==Myelolipoma==
==Myelolipoma==
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==Neuroblastoma==
==Neuroblastoma==
Epi:
===Epidemiology===
*Usually paediatric population.
*Usually paediatric population.


Revision as of 00:54, 22 May 2010

Adrenal gland is a little organ that hangs-out above the kidney. Pathologists rarely see it. It uncommonly is affected by tumours.

Anatomy & histology

Histology

Composed for cortex and medulla.

  • Cortex has three layers - Mnemonic: GFR (from superficial to deep):
    • Zona glomerulosa - salt (e.g. aldosterone)
      • eosinophilic cytoplasm???
      • Normally discontinuous layer.
    • Zona fasciculata - sugar (e.g. cortisol)
      • Clear cytoplasm - key feature.
      • Largest part of the cortex ~ 70%.
      • Cells in cords/nests???
    • Zona reticularis - steroid (e.g. dehydroepiandrosterone).
      • Marked eosinophilia of cytoplasm - key feature.
      • Granular/reticular cytoplasm.
  • Medulla - produces NED: norepinephrine, epinephrine, dopamine.

Benign

  • Spironolactone bodies.[1]
    • Location: zona glomerulosa (where aldosterone is produced).
    • Appearance: eosinophilic spherical laminated whorls.
    • Etiology: long-term use of spironolactone.

Adenomas

Radiology[2]

  • Radiologists are good at identifying adenomas, as they are usually lipid rich and have a characteristic low HU signal.

Treatment is excision if...[3][4]

  • Lesions >30 mm.
  • Hormonally active.
  • Non-incidental finding. (???)

Hyperplasia vs. adenoma

  • Hyperplasia is multifocal.[5]


Neoplasms

Benign neoplasms

Adrenal cortical adenoma

Epidemiology

  • Often an incidental finding.

Pathologic/clinical:

  • May be hormonally active.

Histology

Classic features:

  • Well-defined cell borders.
  • Clear cytoplasm.
  • May have foci of necrosis/degeneration and nuclear atypia.

In aldosterone producing tumours:

  • May extend outside of the capsule (should not be diagnosed as adrenal cortical carcinoma.
  • No atrophy of non-hyperplastic cortex.

In cortisol producing tumours:

  • Atrophy of the non-hyperplastic cortex (due to feedback inhibition from the pituitary gland).

Pheochromocytoma

General

Clinical

  • Paroxysms (i.e. episodic) tachycardia, headache, anxiety.

Epidemiology

  • Tumour arises from medulla
  • Literally means "dusky" (pheo) "colour" (chromo) - dull appearance on gross

Histology

Features:

  • Architecture:
    • Cell nests, auf deutsch: Zellballen (literally Cell balls).
      • Useful for differentiating from ACC.
  • Nuclei.
    • +/-Pleomorphism.
    • Nucleoli may be prominent (not signif. prognostically).
  • Cellular morphology.
    • Polygonal cells.
  • Cytoplasm.
    • Basophilic, granular.
  • Other.
    • Haemorrhagic.

Ganglioneuroma

Micro.[7]

  • Disordered fibrinous material
  • Ganglion cells.
    • Large cells with large nucleus.
      • Prominent nucleolus.

Myelolipoma

Adenomatoid tumour

Malignant neoplasms

Adrenocortical carcinoma (ACC)

Epi.

  • Prognosis sucks.

Microscopic

Features:

  • Very pleomorphic nuclei.
  • High mitotic rate.
  • Atypical mitoses.
  • Eosinophilic cytoplasm.

Malignant pheochromoctyoma

  • Like the description in benign neoplasms.
  • Differentiated from benign pheochromocytoma by mets - often aided by radiologic report.
  • Features useful for differentiating benign from malignant:[8]
    • Marked nuclear atypia.
    • Invasion:
      • Capsular.
      • Vascular.
    • Necrosis.
    • Cellular monotony.
    • Mitoses:
      • Rate.
      • Atypical mitosis.

Neuroblastoma

Epidemiology

  • Usually paediatric population.

Microscopic

  • Small round cell tumour.


Angiosarcoma

?

References

  1. ↑ Kovacs K, Horvath E, Singer W (December 1973). "Fine structure and morphogenesis of spironolactone bodies in the zona glomerulosa of the human adrenal cortex". J. Clin. Pathol. 26 (12): 949-57. PMC 477936. PMID 4131694. http://jcp.bmj.com/cgi/pmidlookup?view=long&pmid=4131694.
  2. ↑ URL: http://emedicine.medscape.com/article/376240-overview.
  3. ↑ PMID 10870039.
  4. ↑ PMID 19035218.
  5. ↑ IAV. 18 February 09.
  6. ↑ EP P.327.
  7. ↑ [need ref]
  8. ↑ EP P.259.
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