Path of Adrenals Flashcards
What is charicteristic of Adenal Cortical ADenoma?
Well circumscribed, yello-orange lesion (high in lipids)
Benign, solitary, well circumscribed
+/- 1 cm with hemmorhage or calcification
Inhibits ACTH production
What is seen on microscopic of Adrenal cortical adenoma?
Vacuolated bc of intracytoplasmic lipid
Mild nuclear pleomorphism
No mitotic activity or necrosis
What is charicteristic of adrenal cortical CA?
HIGHLY Malignant
Lesions Yellow on cut surface, contains hemmorhage, cystic change, and necrosis
Invade vascular channels, mets to LN and viscera, esp LUNG
What are the microscopic traits of anaplastic cells?
1) Pleomorphic cells(diff. stages)
2) Abn nuclear morphology(vary in chromatin content, etc)
3) Mitoses
4) Loss of polarity
How can we differentiate Adrenal Cortical AD from CA?
Metastasis*** Large size Necrosis Mitotic figures Vascular invasion***
What are the charicteristics of Adrenal Cortical Hyperplasia?
Adrenal Cortex is yellow, thickened, and multinodular (hypertrophy and hyperplasia)
What are the 3 clinical hyperadrenal syndromes?
Cushing syndrome (+Cortisol) Hyperaldosteronism Adrenogenital syndromes
What are the 4 different causes of Cushing Syndrome?
Pituitary CS (tumor in ant pit, Ad Hyp) Adrenal CS (tumor in adrenal or nodular hyperplasia) Parneoplastic CS (ACTH prod tumor, lung? Ad Hyp) Iatrogenic CS (exogenous steroid use, Ad Atrophy)
What are the 3 morphologies of Hypercortisolism?
Cortical Hyperplasia
Cortical Adenoma
Cortical Carcinoma
What is the Clinical appearance of Hypercortisolism?
Central Obesity Moon Facies (cant see ears from front, no nose from side) HTN Neuropsych Abn Menstrual Abn Cutaneous Striae
WHat are the charicteristics of Aldosterone-secreting adenoma?
Conn syndrome
Cut surface is yellow/orange
solitary, small, encapsulated lesion
What is the clinical course of Hyperaldosteronism?
HTN
Hypokalemia
High Ald
low blood renin
What are the different patterns of Adrenocortical Insufficiency?
1^ acute ACI (adrenal crisis)
1^ chronic ACI (Addison’s disease)
2^ ACI
What is Waterhouse-Friederichsen syndrome?
Overwhelming septicemic infections caused by Neisseria meningitidis
Massive adrenal hemmorhage w/adrenal insufficency
In children
What are the charicteristics of Addison Disease?
Adults who suffer 90% destruction of Adrenal Gland
What is the morphology of Addison disease?
Autoimmune Adrenitis -small glands -lipid DEPLETION -variable LYMPHOCYTIC infiltrate in cortex SPARES the Adrenal Medulla
What is the clinical course of addison disease?
HIGH POTASSIUM! LOW SODIUM! Fatigue Anorexia Nausea Cutaneous Hyperpigmant Hypotension Elevated ACTH
What is the 5x 10% rule in Pheochromocytoma?
5X 10% 10% Malignant 10% Afunctional 10% Bilateral 10% Extra adrenal 10% Familial
What are the charicteristics of a pheochromocytoma?
Variable size
Cut surface is pale gray or brown, hemmorhage, necrosis, cystic change
Highly vascular
Dichromate Fixitave (Zenker) from oxidation of catecholamines
Neuroendocrine markers
What is the morphology of Pheochromocytoma?
mature polygonal to spindle shaped medullary-type cells basophilic cytoplasmic gran, trabeculae or small nests
Cellular and nuclear pleomorphism
Can only say malignant if it mets
WHat are the clinical features of Pheochromocytoma?
Htn Tachycrdia Headache Apprehension (feel like they're going to die) Sweaty
What is mutated gene in Neuroblastoma?
N-MYC Oncogene
What are the clinical features of Neuroblastoma?
Palp abdominal mass Diastolic HTN Mets to skin and bones Inc Vanillylmandelic Acid metanephrines and Homovanillic acid BLUBERRY MUFFIN BABY
