Difference between revisions of "Adrenal gland"

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==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.
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==Adenomas==
==Adenomas==
Radiology<ref>[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>[http://www.ncbi.nlm.nih.gov/pubmed/10870039]</ref><ref>[http://www.ncbi.nlm.nih.gov/pubmed/19035218]</ref>
Treatment is excision if...<ref name=pmid10870039>PMID 10870039.</ref><ref name=pmid19035218>PMID 19035218.</ref>
*lesions >30 mm
*Lesions >30 mm.
*hormonally active
*Hormonally active.
*non-incidental finding (?)
*Non-incidental finding. (???)


===Hyperplasia vs. adenoma===
===Hyperplasia vs. adenoma===
*Hyperplasia is multifocal.<ref>IAV 18 Feb 09.</ref>
*Hyperplasia is multifocal.<ref>IAV. 18 February 09.</ref>




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==Adrenocortical carcinoma (ACC)==
==Adrenocortical carcinoma (ACC)==
Epi.
Epi.
*prognosis sucks
*Prognosis sucks.


Histology
===Microscopic===
*very pleomorphic nuclei
Features:
*high mitotic rate
*Very pleomorphic nuclei.
*atypical mitoses
*High mitotic rate.
*eosinophilic cytoplasm
*Atypical mitoses.
*Eosinophilic cytoplasm.


==Malignant pheochromoctyoma==
==Malignant pheochromoctyoma==
*like the description in ''benign neoplasms''
*Like the description in ''benign neoplasms''.
*differentiated from benign pheochromocytoma by mets - often aided by radiologic report
*Differentiated from benign pheochromocytoma by mets - often aided by radiologic report.
*features useful for differentiating benign from malignant:<ref>[EP P.259]</ref>
*Features useful for differentiating benign from malignant:<ref>EP P.259.</ref>
**marked nuclear atypia
**Marked nuclear atypia.
**invasion
**Invasion:
***capsular
***Capsular.
***vascular
***Vascular.
**necrosis
**Necrosis.
**cellular monotony
**Cellular monotony.
**mitoses
**Mitoses:
***rate
***Rate.
***atypical mitosis
***Atypical mitosis.


==Neuroblastoma==
==Neuroblastoma==
Epi:  
Epi:  
*usually paediatric population
*Usually paediatric population.


Histology
===Microscopic===
*small blue cells
*Small round cell tumour.




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==References==
==References==
<references/>
{{reflist|2}}


[[Category:Endocrine pathology]]
[[Category:Endocrine pathology]]
[[Category:Genitourinary pathology]]
[[Category:Genitourinary pathology]]
----------------------------------------------------------------
'''Paraganglioma'''
General
*def'n: tumour of paraganglion (can be sympathetic or parasympathetic)
**most common paraganglioma - pheochromocytoma<ref>[EP P.327]</ref>
*head & neck most common site - after abdomen
**carotid body tumour
Epi.
*very rare
*rarely malignant
*familial syndromes assoc. with paragangliomas<ref>[EP. P.328]</ref>
**[[von Hippel Lindau]]
**Hereditary paragangliomatosis
**Neurofibromatosis type 1 (von Recklinghausen disease)
**MEN 2A
**MEN 2B
Clinical
*10% bilateral, multiple, familial, pediatric and malignant<ref>[EP P.327]</ref>
Micro.<ref>[EP PP.329-332]</ref>
*resembles pheochromocytoma
**Zellballen (literally: "cell balls") - nests of cells
**fibrovascular septae
**finely granular cytoplasm (salt-and-pepper nuclei)
IHC<ref>EP P.335</ref>
*chromogranin +ve
*synaptophysin +ve
*S100 +/-
*cytokeratin -ve
*EMA -ve
**+ve in RCC
==See also==
*[[Pheochromocytoma]]
==References==
<references/>
[[Category:Rare stuff]]

Revision as of 00:48, 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 epinephrine

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

Epi:

  • 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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