Pathology of the adrenal glands Flashcards
what are the primary adrenal cortical neoplasms?
cortical adenoma
cortical carcinoma
adrenal cortical adenoma: morphology
- well circumscribed, yellow-orange lesions
- may lie within cortex or protrude into medulla or the subscapular region
adrenal cortical adenoma: histology
- vacuolated cells due to intracytoplasmic lipid
- mild nuclear pleomorphism
- NO mitotic activity or necrosis
adrenal cortical carcinoma: morphology
yellow on cut surface, but usually contains areas of hemorrhage, cystic change, and necrosis
adrenal cortical carcinoma: histology
range of well differentiated to markedly anaplastic cells
how do adrenal cortical carcinomas typically invade?
vascular channels with metastases to regional lymph nodes and to viscera, especially lung
what is anaplasia? what morphological changes is it associated with?
lack of differentiation
- pleomorphism
- abnormal nuclear morphology
- mitoses
- loss of polarity
how does adrenal cortical hyperplasia compare with normal adrenal tissue?
adrenal cortex is yellow, thickened, and multinodular
what are the three distinctive clinical hyperadrenal syndromes?
- cushing syndrome (excess cortisol)
- hyperaldosteronism (excess mineralocorticoids)
- adrenogenital syndrome (excess androgens)
cushing syndrome is caused by _________________
elevation in glucocorticoid levels
what are the four causes of cushing syndrome?
pituitary
adrenal
paraneoplastic
iatrogenic (steroid excess)
cushing’s disease
excess ACTH coming from the pituitary gland
what is the most common cause of primary hyperaldosteronism?
- aldosterone producing adrenocortical neoplasm, usually an adenoma
- primary adrenocortical hyperplasia
what is conn syndrome?
a solitary aldosterone secreting adenoma
aldosterone producing adenomas (conn syndrome): morphology
- usually small, solitary, encapsulated
- cut surface is usually bright yellow, reflecting high lipid content
what is the clinical course of hyperaldosteronism?
- hypertension
- hypokalemia
- high aldosterone, low blood renin
what are the different types of adrenocortical insufficiency?
- primary acute adrenocortical insufficiency (adrenal crisis)
- primary chronic adrenocortical insufficiency (addison)
- secondary adrenocortical insufficiency
what is waterhouse-friedrichsen syndrome? what is the result? what is the typical patient population?
overwhelming septicemic infection due to neisseria meningitidis infection
results in massive adrenal hemorrhage with adrenal insufficiency
children
what is the morphology of addison disease?
autoimmune adrenalitis producing
- small glands
- lipid depletion of cortex
- variable lymphocytic infiltrate in cortex
addison disease: signs and symptoms
fatigue anorexia nausea cutaneous hyperpigmentation hypotension elevated ACTH high potassium low sodium
secondary adrenocortical insufficiency: typical morphology
- variable degrees of atrophy of the adrenal cortex
- sparing of the zona glomerulosa and medulla
what are the aldosterone and pigmentation levels like in secondary adrenocortical insufficiency?
NO hyperpigmentation normal aldosterone (it is independent of ACTH)
which neuroendocrine markers are positive in pheochromocytoma?
synaptophysin
chromogranin
pheochromocytoma: histology
mature polygonal to spindle-shaped medullary-type cells containing basophilic cytoplasmic granules arrayed in trabeculae or small nests
where do neuroblastomas arise?
adrenal medulla or in extra-adrenal paraganglia
neuroblastomas involve an amplification of what oncogene?
N-MYC
neuroblastoma: histology
- “small blue cell tumors”
- homer-wright rosettes (neuroblasts located around a central space)
neuroblastoma: clinical findings
- palpable abdominal mass
- diastolic hypertension
- commonly metastasizes to skin and bones
- increased vanillylmandelic acid (VMA)
- increased metanephrines
- increased homovanillic acid (HVA)
neuroblastoma: presentation
“blueberry muffin baby”
