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Difference between revisions of "Adrenal cortical adenoma"
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| LMDDx = adrenal cortical nodule, [[adrenal cortical hyperplasia]], [[adrenal cortical carcinoma]] | | LMDDx = adrenal cortical nodule, [[adrenal cortical hyperplasia]], [[adrenal cortical carcinoma]] | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = [[calretinin]], inhibin | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
| Line 28: | Line 28: | ||
| Other = | | Other = | ||
| ClinDDx = | | ClinDDx = | ||
| Tx = | | 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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*[[Adrenal cortical hyperplasia]]. | *[[Adrenal cortical hyperplasia]]. | ||
**Hyperplasia is multifocal.<ref>IAV. 18 February 2009.</ref> | **Hyperplasia is multifocal.<ref>IAV. 18 February 2009.</ref> | ||
*[[Adrenal cortical carcinoma]]. | *[[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=== | ===Images=== | ||
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Image: Adrenal LipoAdenoma MP PA.JPG|Adrenal cortical adenoma with fat - "lipoadenoma" (SKB) | Image: Adrenal LipoAdenoma MP PA.JPG|Adrenal cortical adenoma with fat - "lipoadenoma" (SKB) | ||
</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]] | ||