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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Primary aldosteronism (1) adrenocortical adenoma.jpg | |||
| Width = | |||
| Caption = Adrenal cortical adenoma. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = | |||
| Subtypes = | |||
| LMDDx = adrenal cortical nodule, [[adrenal cortical hyperplasia]], [[adrenal cortical carcinoma]] | |||
| Stains = | |||
| IHC = [[calretinin]], inhibin | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[adrenal gland]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = relatively common | |||
| Bloodwork = | |||
| Rads = adrenal mass, HU<10 | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = | |||
| Tx = followup or surgical excision | |||
}} | |||
'''Adrenal cortical adenoma''', also '''adrenocortical adenoma''' and '''adrenal adenoma''', is a relatively common benign pathology of the [[adrenal gland]]. | '''Adrenal cortical adenoma''', also '''adrenocortical adenoma''' and '''adrenal adenoma''', is a relatively common benign pathology of the [[adrenal gland]]. | ||
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*Can be a cause of [[hypertension]].<ref name=pmid18584586/> | *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 | *Radiologists are good at identifying adenomas, as they are usually lipid rich and have a characteristic low HU signal (<10 HU<ref name=pmid24636681>{{Cite journal | last1 = Tenenbaum | first1 = F. | last2 = Lataud | first2 = M. | last3 = Groussin | first3 = L. | title = [Update in adrenal imaging]. | journal = Presse Med | volume = 43 | issue = 4 Pt 1 | pages = 410-9 | month = Apr | year = 2014 | doi = 10.1016/j.lpm.2014.02.002 | PMID = 24636681 }}</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> | **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> | ||
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*May have foci of [[necrosis]]/degeneration and nuclear atypia. | *May have foci of [[necrosis]]/degeneration and nuclear atypia. | ||
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 ''Weiss criteria'' below. | |||
====Weiss criteria==== | |||
The diagnosis of ''adrenal cortical carcinoma'' requires three of the following:<ref name=pmid20551521>{{cite journal |author=Jain M, Kapoor S, Mishra A, Gupta S, Agarwal A |title=Weiss criteria in large adrenocortical tumors: a validation study |journal=Indian J Pathol Microbiol |volume=53 |issue=2 |pages=222–6 |year=2010 |pmid=20551521 |doi=10.4103/0377-4929.64325 |url=}}</ref><ref name=pmid6703192>{{Cite journal | last1 = Weiss | first1 = LM. | title = Comparative histologic study of 43 metastasizing and nonmetastasizing adrenocortical tumors. | journal = Am J Surg Pathol | volume = 8 | issue = 3 | pages = 163-9 | month = Mar | year = 1984 | doi = | PMID = 6703192 }}</ref> | |||
#High nuclear grade. | |||
#High mitotic rate; >5/50 HPF (@ 40X obj.) - definition suffers from [[HPFitis]]. | |||
#Atypical mitoses. | |||
#Cleared cytoplasm in <= 25% of tumour cells. | |||
#Sheeting (diffuse architecture) in >= 1/3 of tumour cells. | |||
#Necrosis in nests. | |||
#Venous invasion. | |||
#Adrenal sinusoid invasion; [[lymphovascular space invasion]] within the [[adrenal gland]]. | |||
#Capsular invasion. | |||
===Images=== | |||
<gallery> | <gallery> | ||
Image: Adrenal CorticalAdenoma DSCN5001 PA.JPG|Adrenal Cortical Adenoma (SKB) | Image: Adrenal CorticalAdenoma DSCN5001 PA.JPG|Adrenal Cortical Adenoma (SKB) | ||
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</gallery> | </gallery> | ||
==IHC== | |||
* | Features:<ref name=pmid11893039>{{cite journal |authors=Jorda M, De MB, Nadji M |title=Calretinin and inhibin are useful in separating adrenocortical neoplasms from pheochromocytomas |journal=Appl. Immunohistochem. Mol. Morphol. |volume=10 |issue=1 |pages=67–70 |date=March 2002 |pmid=11893039 |doi=10.1097/00129039-200203000-00012 |url=}}</ref> | ||
* | *[[Calretinin]] +ve. | ||
*Inhibin +ve. | |||
Note: | |||
*Calretinin and inhibin in combination are useful for adrenal versus [[pheochromocytoma]].<ref name=pmid11893039/> | |||
==Sign out== | |||
<pre> | |||
Adrenal Gland, Right, Adrenalectomy: | |||
- Adrenal cortical adenoma. | |||
</pre> | |||
===Microscopic=== | |||
<pre> | |||
The sections show a benign adrenal gland with an expanded cortex. | |||
Clearing of the cytoplasm is present in the cortex. | |||
None of the following are present in the cortex: | |||
High nuclear grade, high mitotic rate (mitotic activity 1/50 HPF, | |||
* | where 1 HPF~=0.2376 mm*mm), atypical mitoses, sheeting, necrosis, | ||
sinusoidal invasion, venous invasion, capsular invasion. | |||
</pre> | |||
==See also== | ==See also== | ||
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==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
[[Category:Adrenal gland]] | [[Category:Adrenal gland]] | ||
[[Category:Diagnosis]] | [[Category:Diagnosis]] |
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