Difference between revisions of "Adrenal gland"

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Adrenal insuff. may be immediately post-op.<ref>URL: [http://ats.ctsnetjournals.org/cgi/content/full/62/5/1516 http://ats.ctsnetjournals.org/cgi/content/full/62/5/1516]. Accessed on: 21 August 2010.</ref>
Adrenal insuff. may be immediately post-op.<ref>URL: [http://ats.ctsnetjournals.org/cgi/content/full/62/5/1516 http://ats.ctsnetjournals.org/cgi/content/full/62/5/1516]. Accessed on: 21 August 2010.</ref>


==Benign==
=Benign=
===Spironolactone bodies===
==Spironolactone bodies==
Features:<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>
Features:<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).
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*[http://commons.wikimedia.org/wiki/File:Spironolactone_bodies.png SB (circled) - cropped high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Spironolactone_bodies.png SB (circled) - cropped high mag. (WC)].


==Hemorrhagic adrenalitis==
===General===
*[[AKA]] ''Waterhouse-Friderichsen syndrome''.
*Classically thought to be only due to ''Neisseria meningitidis''; however, more recently also associated with ''Streptococcus aureus''.<ref name=pmid16177250>{{cite journal |author=Adem PV, Montgomery CP, Husain AN, ''et al.'' |title=Staphylococcus aureus sepsis and the Waterhouse-Friderichsen syndrome in children |journal=N. Engl. J. Med. |volume=353 |issue=12 |pages=1245–51 |year=2005 |month=September |pmid=16177250 |doi=10.1056/NEJMoa044194 |url=}}</ref><ref name=pmid14747454>{{cite journal |author=Hamilton D, Harris MD, Foweraker J, Gresham GA |title=Waterhouse-Friderichsen syndrome as a result of non-meningococcal infection |journal=J. Clin. Pathol. |volume=57 |issue=2 |pages=208–9 |year=2004 |month=February |pmid=14747454 |pmc=1770213 |doi= |url=}}</ref>
==Gross==
Features:
*Massive haemorrhage within the substance of the adrenal gland.
DDx (autopsy):
*Post-mortem changes.
==Microscopic==
Features:
*Massive haemorrhage within the substance of the adrenal gland.
Image: [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770213/figure/f1/ Haemorrhage in adrenal (nih.gov)].
=Benign neoplasms=
==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>
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===Hyperplasia vs. adenoma===
===Hyperplasia vs. adenoma===
*Hyperplasia is multifocal.<ref>IAV. 18 February 2009.</ref>
*Hyperplasia is multifocal.<ref>IAV. 18 February 2009.</ref>
==Neoplasms==
===Benign neoplasms===


==Adrenal cortical adenoma==
==Adrenal cortical adenoma==
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See: ''[[Uterine_tumours#Adenomatoid_tumour|Adenomatoid tumours (uterine tumours)]]''.
See: ''[[Uterine_tumours#Adenomatoid_tumour|Adenomatoid tumours (uterine tumours)]]''.


===Malignant neoplasms===
=Malignant neoplasms=
==Adrenocortical carcinoma (ACC)==
==Adrenocortical carcinoma (ACC)==
Epidemiology:
Epidemiology:
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*See: ''[[Small round cell tumours]]''.
*See: ''[[Small round cell tumours]]''.


==See also==
=See also=
*[[Small round cell tumours]].
*[[Small round cell tumours]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Endocrine pathology]]
[[Category:Endocrine pathology]]
[[Category:Genitourinary pathology]]
[[Category:Genitourinary pathology]]

Revision as of 17:57, 8 October 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.

Clinical

Patients getting a bilat. adrenalectomy get pre-treatment with steroids.[1]

Adrenal insuff. may be immediately post-op.[2]

Benign

Spironolactone bodies

Features:[3]

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

Images:

Hemorrhagic adrenalitis

General

  • AKA Waterhouse-Friderichsen syndrome.
  • Classically thought to be only due to Neisseria meningitidis; however, more recently also associated with Streptococcus aureus.[4][5]

Gross

Features:

  • Massive haemorrhage within the substance of the adrenal gland.

DDx (autopsy):

  • Post-mortem changes.

Microscopic

Features:

  • Massive haemorrhage within the substance of the adrenal gland.

Image: Haemorrhage in adrenal (nih.gov).

Benign neoplasms

Adenomas

Radiology[6]

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

Treatment is excision if...[7][8]

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

Hyperplasia vs. adenoma

  • Hyperplasia is multifocal.[9]

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

Microscopic

Features:

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

Myelolipoma

Adenomatoid tumour

See: Adenomatoid tumours (uterine tumours).

Malignant neoplasms

Adrenocortical carcinoma (ACC)

Epidemiology:

  • 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:[11]
    • Marked nuclear atypia.
    • Invasion:
      • Capsular.
      • Vascular.
    • Necrosis.
    • Cellular monotony.
    • Mitoses:
      • Rate.
      • Atypical mitosis.

Neuroblastoma

Epidemiology

  • Usually paediatric population.

Microscopic

Features:

See also

References

  1. ↑ URL: http://www3.interscience.wiley.com/cgi-bin/fulltext/119909358/PDFSTART. Accessed on: 21 August 2010.
  2. ↑ URL: http://ats.ctsnetjournals.org/cgi/content/full/62/5/1516. Accessed on: 21 August 2010.
  3. ↑ 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.
  4. ↑ Adem PV, Montgomery CP, Husain AN, et al. (September 2005). "Staphylococcus aureus sepsis and the Waterhouse-Friderichsen syndrome in children". N. Engl. J. Med. 353 (12): 1245–51. doi:10.1056/NEJMoa044194. PMID 16177250.
  5. ↑ Hamilton D, Harris MD, Foweraker J, Gresham GA (February 2004). "Waterhouse-Friderichsen syndrome as a result of non-meningococcal infection". J. Clin. Pathol. 57 (2): 208–9. PMC 1770213. PMID 14747454. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770213/.
  6. ↑ URL: http://emedicine.medscape.com/article/376240-overview.
  7. ↑ Luton, JP.; Martinez, M.; Coste, J.; Bertherat, J. (Jul 2000). "Outcome in patients with adrenal incidentaloma selected for surgery: an analysis of 88 cases investigated in a single clinical center.". Eur J Endocrinol 143 (1): 111-7. PMID 10870039.
  8. ↑ Liu, XK.; Liu, XJ.; Dong, X.; Kong, CZ. (Jun 2008). "[Clinical research about treatment for adrenal incidentalomas]". Zhonghua Wai Ke Za Zhi 46 (11): 832-4. PMID 19035218.
  9. ↑ IAV. 18 February 2009.
  10. ↑ Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 327. ISBN 978-0443066856.
  11. ↑ Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 259. ISBN 978-0443066856.
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