Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        Primary Adrenal Gland Tumors
      
Primary Adrenal Gland Tumors
NOTE: when recording weight, there is "specimen weight" and there is tumor weight (a recent case was adenoma only 25% of total specimen...organizing intra-adenoma hemorrhage accounting for 75% of specimen weight [LMC-05-575]).
  • Adrenal Cortical
  1. incidental hyperplastic nodule: (patient systemically asymptomatic; <1.0 cm. nodule & normal cortex otherwise).
  2. nodular hyperplasia with a dominant nodule: cortex is otherwise hyperplastic...often seen in autopsies.
  3. adenoma (ACA): patient systemically asymptomatic vs. Cushing's vs. hyperaldosteronism vs. virilization. Size: rarely larger than 5cm or 50 grams. Interstitial mast cells hint at over-secretion of mineralocorticoids. May be black (r/o melanoma). May be very hemorrhagic (r/o vascular tumor). Most adenomas are straightforward [LMC-04-9645, 31 g.]. Ki-67 8% or less3.
  4. oncocytoma: like other oncocytomas.
  5. borderline adenoma-carcinoma (adrenal cortical neoplasm of indeterminate or uncertain malignant potential): [LMC-03-8469, 49 g.]
  6. carcinoma: Most carcinomas are obvious & straightforward [1.0CM ca. LMC-05-3324]; they have a Ki-67 about 20% & over 8%3. [adenoma vs. ca. criteria]
  7. unless showing histological extremes, there is no sharp & absolute distinction between benign & malignant.
  • Adrenal medullary
  1. pheochromocytoma blood test. Benign tends to be circumscribed, & malignant not; S-100 positive sustentacular cells can be as nicely present in malignant as in benign. Ki-67 greater than 3% is 100% specific for malignant but only 50% sensitive (benign is 0.5-3% & malignant is 1-18%)3.
  2. others [combined pheo & ganglioneuroma, LMC-05-5796]

References:

  1. Weidner, Noel, The Difficult Diagnosis in Surgical Pathology, 944 pages; 1996.
  2. Rosai J, Rosai & Ackerman's Surgical Pathology, 9th Edition, 2004 (EBS).
  3. Ronald A. DeLellis , MD, Pathologist-in-Chief @ Lifespan Academic Med. Ctr in Providence, Rhode Island. He has served on key committees, including the WHO Project on Classification of Endocrine Tumoprs. He was a speaker at The Second International Course in Applied Immunohistochemistry and Molecular Pathology (Santa Barbara, Calif. 1/28/08-2/1/08).

   (posted 20 December 2003; latest addition 30 January 2008)
 
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