Difference between revisions of "Adrenal gland"

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==Clinical==
==Clinical==
Patients getting a bilat. adrenalectomy get pre-treatment with steroids.
Patients getting a bilat. adrenalectomy get pre-treatment with steroids.<ref>URL:
http://www3.interscience.wiley.com/cgi-bin/fulltext/119909358/PDFSTART
[http://www3.interscience.wiley.com/cgi-bin/fulltext/119909358/PDFSTART http://www3.interscience.wiley.com/cgi-bin/fulltext/119909358/PDFSTART]. Accessed on: 21 August 2010.</ref>


Adrenal insuff. may be immediately post-op.
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>
http://ats.ctsnetjournals.org/cgi/content/full/62/5/1516===


==Benign==
==Benign==
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*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>{{Cite journal  | last1 = Luton | first1 = JP. | last2 = Martinez | first2 = M. | last3 = Coste | first3 = J. | last4 = Bertherat | first4 = J. | title = Outcome in patients with adrenal incidentaloma selected for surgery: an analysis of 88 cases investigated in a single clinical center. | journal = Eur J Endocrinol | volume = 143 | issue = 1 | pages = 111-7 | month = Jul | year = 2000 | doi =  | PMID = 10870039 }}
</ref><ref name=pmid19035218>{{Cite journal  | last1 = Liu | first1 = XK. | last2 = Liu | first2 = XJ. | last3 = Dong | first3 = X. | last4 = Kong | first4 = CZ. | title = [Clinical research about treatment for adrenal incidentalomas] | journal = Zhonghua Wai Ke Za Zhi | volume = 46 | issue = 11 | pages = 832-4 | month = Jun | year = 2008 | doi =  | PMID = 19035218 }}</ref>
*Lesions >30 mm.
*Lesions >30 mm.
*Hormonally active.
*Hormonally active.
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===Hyperplasia vs. adenoma===
===Hyperplasia vs. adenoma===
*Hyperplasia is multifocal.<ref>IAV. 18 February 09.</ref>
*Hyperplasia is multifocal.<ref>IAV. 18 February 2009.</ref>




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==Pheochromocytoma==
==Pheochromocytoma==
===General===
===General===
*Considered to be a [[paraganglioma]].<ref>EP P.327.</ref>
*Considered to be a [[paraganglioma]].<ref name=Ref_EP327>{{Ref EP|327}}</ref>


===Clinical===
===Clinical===
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==Ganglioneuroma==
==Ganglioneuroma==
Micro.<ref>[need ref]</ref>
===Microscopic===
*Disordered fibrinous material
Features:
*Ganglion cells.
*Ganglion cells - '''key feature'''.
**Large cells with large nucleus.
**Large cells with large nucleus.
***Prominent nucleolus.
***Prominent nucleolus.
*Disordered fibrinous material.


==Myelolipoma==
==Myelolipoma==


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


===Malignant neoplasms===
===Malignant neoplasms===
==Adrenocortical carcinoma (ACC)==
==Adrenocortical carcinoma (ACC)==
Epi.
Epidemiology:
*Prognosis sucks.
*Prognosis sucks.


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*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 name=Ref_EP259>{{Ref EP|259}}</ref>
**Marked nuclear atypia.
**Marked nuclear atypia.
**Invasion:
**Invasion:
Line 135: Line 137:


===Microscopic===
===Microscopic===
*Small round cell tumour.
Features:
 
*See: ''[[Small round cell tumours]]''.


==References==
==References==

Revision as of 03:42, 22 August 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.[3]
    • Location: zona glomerulosa (where aldosterone is produced).
    • Appearance: eosinophilic spherical laminated whorls.
    • Etiology: long-term use of spironolactone.

Adenomas

Radiology[4]

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

Treatment is excision if...[5][6]

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

Hyperplasia vs. adenoma

  • Hyperplasia is multifocal.[7]


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

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:[9]
    • Marked nuclear atypia.
    • Invasion:
      • Capsular.
      • Vascular.
    • Necrosis.
    • Cellular monotony.
    • Mitoses:
      • Rate.
      • Atypical mitosis.

Neuroblastoma

Epidemiology

  • Usually paediatric population.

Microscopic

Features:

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. ↑ URL: http://emedicine.medscape.com/article/376240-overview.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ IAV. 18 February 2009.
  8. ↑ Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 327. ISBN 978-0443066856.
  9. ↑ 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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