Difference between revisions of "Adrenal cortical adenoma"

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#redirect [[Adrenal_gland#Adrenal_cortical_adenoma]]
'''Adrenal cortical adenoma''', also '''adrenocortical adenoma''' and '''adrenal adenoma''', is a relatively common benign pathology of the [[adrenal gland]].


==General==
Epidemiology:
*Often an incidental finding.
Pathologic/clinical:
*May be hormonally active.
*Can be a cause of [[hypertension]].<ref name=pmid18584586/>
*Radiologists are good at identifying adenomas, as they are usually lipid rich and have a characteristic low HU signal.<ref>URL: [http://emedicine.medscape.com/article/376240-overview http://emedicine.medscape.com/article/376240-overview].</ref>
**Microadenomas may be missed.<ref name=pmid18584586/><ref name=pmid20881759>{{Cite journal  | last1 = Fujiwara | first1 = M. | last2 = Murao | first2 = K. | last3 = Imachi | first3 = H. | last4 = Yoshida | first4 = K. | last5 = Muraoka | first5 = T. | last6 = Ohyama | first6 = T. | last7 = Kushida | first7 = Y. | last8 = Haba | first8 = R. | last9 = Kakehi | first9 = Y. | title = Misdiagnosis of two cases of primary aldosteronism owing to failure of computed tomography to detect adrenal microadenoma. | journal = Am J Med Sci | volume = 340 | issue = 4 | pages = 335-7 | month = Oct | year = 2010 | doi = 10.1097/MAJ.0b013e3181e95587 | PMID = 20881759 }}</ref>
Indications for excision:<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.
*Hormonally active.
*Non-incidental finding. (???)
*Adrenal vein sampling (AVS) suggestive of adenoma.<ref name=pmid18584586>{{Cite journal  | last1 = Myint | first1 = KS. | last2 = Watts | first2 = M. | last3 = Appleton | first3 = DS. | last4 = Lomas | first4 = DJ. | last5 = Jamieson | first5 = N. | last6 = Taylor | first6 = KP. | last7 = Coghill | first7 = S. | last8 = Brown | first8 = MJ. | title = Primary hyperaldosteronism due to adrenal microadenoma: a curable cause of refractory hypertension. | journal = J Renin Angiotensin Aldosterone Syst | volume = 9 | issue = 2 | pages = 103-6 | month = Jun | year = 2008 | doi = 10.3317/jraas.2008.015 | PMID = 18584586 }}</ref>
Notes:
*[[Cushing disease]] is due to the ACTH over-production by the [[pituitary]].
*In cortisol producing tumours (''Cushing syndrome''): atrophy of the non-hyperplastic cortex (due to feedback inhibition from the [[pituitary gland]]).
==Microscopic==
Classic features:
*Well-defined cell borders.
*Clear cells (abundant, finely vacuolated cytoplasm)
*Polygonal pink cells.
*Most of the nuclei are bland, central and round.
*May have foci of [[necrosis]]/degeneration and nuclear atypia.
<gallery>
Image: Adrenal CorticalAdenoma DSCN5001 PA.JPG|Adrenal Cortical Adenoma (SKB)
Image: Adrenal CorticalAdenoma DSCN5002 PA.JPG|Adrenal Cortical Adenoma (SKB)
Image: Adrenal CorticalAdenoma DSCN5004 PA.JPG|Adrenal Cortical Adenoma (SKB)
Image: Adrenal CorticalAdenoma DSCN5005 PA.JPG|Adrenal Cortical Adenoma (SKB)
Image: Adrenal CorticalAdenoma MP CTR.jpg|Adrenal Cortical Adenoma - Medium power (SKB)
Image: Adrenal CorticalAdenoma HP CTR.jpg|Adrenal Cortical Adenoma - High power.  Abundant clear cytoplasm.  Round, regular nuclei. (SKB)
Image: Adrenal CorticalAdenoma MP PA.JPG|Adrenal Cortical Adenoma - Some pleomorphism - Medium power (SKB)
Image: Adrenal LipoAdenoma MP PA.JPG|Adrenal cortical adenoma with fat - "lipoadenoma" (SKB)
</gallery>
Note:
*In aldosterone producing tumours:
**May extend outside of the capsule (should ''not'' be diagnosed as ''[[adrenal cortical carcinoma]]'').
**No atrophy of non-hyperplastic cortex.
**May show spironolactone bodies if hypertension treated with spironolactone prior to surgery.
DDx:
*Adrenal cortical nodule.<ref name=Ref_EP200>{{Ref EP|200}}</ref>
*[[Adrenal cortical hyperplasia]].
**Hyperplasia is multifocal.<ref>IAV. 18 February 2009.</ref>
*[[Adrenal cortical carcinoma]].
==See also==
*[[Adrenal gland]].
==References==
{{Refist|1}}
[[Category:Adrenal gland]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Revision as of 05:53, 9 May 2015

Adrenal cortical adenoma, also adrenocortical adenoma and adrenal adenoma, is a relatively common benign pathology of the adrenal gland.

General

Epidemiology:

  • Often an incidental finding.

Pathologic/clinical:

  • Radiologists are good at identifying adenomas, as they are usually lipid rich and have a characteristic low HU signal.[2]
    • Microadenomas may be missed.[1][3]

Indications for excision:[4][5]

  • Lesions >30 mm.
  • Hormonally active.
  • Non-incidental finding. (???)
  • Adrenal vein sampling (AVS) suggestive of adenoma.[1]

Notes:

  • Cushing disease is due to the ACTH over-production by the pituitary.
  • In cortisol producing tumours (Cushing syndrome): atrophy of the non-hyperplastic cortex (due to feedback inhibition from the pituitary gland).

Microscopic

Classic features:

  • Well-defined cell borders.
  • Clear cells (abundant, finely vacuolated cytoplasm)
  • Polygonal pink cells.
  • Most of the nuclei are bland, central and round.
  • May have foci of necrosis/degeneration and nuclear atypia.

  • Adrenal Cortical Adenoma (SKB)

  • Adrenal Cortical Adenoma (SKB)

  • Adrenal Cortical Adenoma (SKB)

  • Adrenal Cortical Adenoma (SKB)

  • Adrenal Cortical Adenoma - Medium power (SKB)

  • Adrenal Cortical Adenoma - High power. Abundant clear cytoplasm. Round, regular nuclei. (SKB)

  • Adrenal Cortical Adenoma - Some pleomorphism - Medium power (SKB)

  • Adrenal cortical adenoma with fat - "lipoadenoma" (SKB)

Note:

  • In aldosterone producing tumours:
    • May extend outside of the capsule (should not be diagnosed as adrenal cortical carcinoma).
    • No atrophy of non-hyperplastic cortex.
    • May show spironolactone bodies if hypertension treated with spironolactone prior to surgery.

DDx:

See also

References

Template:Refist

  1. ↑ 1.0 1.1 1.2 Myint, KS.; Watts, M.; Appleton, DS.; Lomas, DJ.; Jamieson, N.; Taylor, KP.; Coghill, S.; Brown, MJ. (Jun 2008). "Primary hyperaldosteronism due to adrenal microadenoma: a curable cause of refractory hypertension.". J Renin Angiotensin Aldosterone Syst 9 (2): 103-6. doi:10.3317/jraas.2008.015. PMID 18584586.
  2. ↑ URL: http://emedicine.medscape.com/article/376240-overview.
  3. ↑ Fujiwara, M.; Murao, K.; Imachi, H.; Yoshida, K.; Muraoka, T.; Ohyama, T.; Kushida, Y.; Haba, R. et al. (Oct 2010). "Misdiagnosis of two cases of primary aldosteronism owing to failure of computed tomography to detect adrenal microadenoma.". Am J Med Sci 340 (4): 335-7. doi:10.1097/MAJ.0b013e3181e95587. PMID 20881759.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 200. ISBN 978-0443066856.
  7. ↑ IAV. 18 February 2009.
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