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Endo > SM_179b: Adrenal Pathology: Cortex/Medulla > Flashcards

SM_179b: Adrenal Pathology: Cortex/Medulla Flashcards

1
Q

Outside of adrenal gland is ____ and inside is ____

A

Outside of adrenal gland is cortex and inside is medulla

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2
Q

Describe histology of adrenal gland

A

Adrenal gland histology

  1. Capsule (outside)
  2. Zona glomerulosa
  3. Zona fasciculata
  4. Zona reticularis
  5. Medulla
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3
Q

Zone glomerulosa of adrenal gland produces ____

A

Zone glomerulosa of adrenal gland produces mineralocorticoids

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4
Q

Zone fasciculata of adrenal gland produces ____

A

Zone fasciculata of adrenal gland produces glucocorticoids

(largest layer by volume)

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5
Q

Zone reticularis of adrenal gland produces ____

A

Zone reticularis of adrenal gland produces androgens

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6
Q

Describe adrenal pathology

A

Adrenal pathology

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7
Q

Atrophic adrenal cortex is ___

A

Atrophic adrenal cortex is hypofunctional

(hyperplastic is hyperfunctional)

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8
Q

Describe causes of hypofunction of the adrenal cortex

A

Adrenal cortex hypofunction

  • Pituitary insufficiency
  • Addison’s disease (chronic adrenal insufficiency): usually autoimmune
  • Abrupt withdrawal of steroid therapy (iatrogenic)
  • Waterhouse Friderichsen Syndrome
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9
Q

Adrenal cortical hypofunction is caused by ____ and presents as ____, ____, ____, and ____

A

Adrenal cortical hypofunction is caused by atrophic cortex and presents as fatigue, hypotension, hyperpigmentation, and hyperkalemia

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10
Q

Waterhouse Friderichsen syndrome is ____ with pathological findings of ____ and ____

A

Waterhouse Friderichsen syndrome is acute adrenal failure (cortex) with pathological findings of hemorrhage and necrosis

  • Often caused by meningococcal sepsis, DIC, or severe hypotension
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11
Q

Describe causes of adrenal cortex hyperfunction

A

Adrenal cortex hyperfunction

  • ACTH secreting pituitary adenoma (Cushing’s disease)
  • Other ACT secreting tumors (lung carcinoma, etc)
  • Primary adrenal cortical hyperplasia
  • Cortisol producing adrenal cortical tumors
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12
Q

Increased cortisol levels, central obesity, moon facies, purple striae, and hirsutism is ____

A

Increased cortisol levels, central obesity, moon facies, purple striae, and hirsutism is Cushing’s syndrome

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13
Q

Types of cortical hyperplasia are ____, ____, and ____

A

Types of cortical hyperplasia are diffuse hyperplasia, micronodular hyperplasia, and macronodular hyperplasioa

  • Diffuse: diffuse symmetric enlargement of the cortex
  • Micronodular: multiple nodules present, all < 1.0 cm
  • Macronodular: multiple nodules present, some > 1.0 cm
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14
Q

Most adult adrenal masses are ____

A

Most adult adrenal masses are non-functioning cortical adenoma

  • Pheochromocytoma and metastatic carcinoma are next most common
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15
Q

Cushing’s disease is when ____

A

Cushing’s disease is when pituitary (adenoma or hyperplasia) produces excess ACTH leading to Cushing’s syndrome

  • Cushing’s syndrome: increased cortisol levels, central obesity, moon facies, purple striae, and hirsutism
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16
Q

____ is the most common adrenal tumor and is most often non-functional

A

Adrenal cortical adenoma is the most common adrenal tumor and is most often non-functional

  • Often discovered incidentally
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17
Q

Describe functional cortical adenoma

A

Functional cortical adenoma

  • Aldosterone producing adenoma (Conn syndrome)
  • Glucocorticoid producing adenoma (Cushing syndrome)
  • Androgen producing adenomas associated with feminization or virilization
  • Adenomas with mixed hormone production
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18
Q

Describe inherited syndromes associated with adrenal cortical syndrome

A

Inherited syndromes associated with adrenal cortical syndrome

  • Beckwith-Weidemann syndrome
  • Multiple endocrine neoplasia type 1 (MEN 1: Wermer syndrome)
  • Hyperparathyroidism jaw tumor syndrome
  • Li Fraumeni syndrome
  • Gardner syndrome
19
Q

Adrenal ___ is often > 6.5 cm and weights often > 100 g

A

Adrenal cortical carcinoma is often > 6.5 cm and weights often > 100 g

20
Q

Describe the criteria for cortical carcinoma

A

Criteria for cortical carcinoma: need > 3 criteria

  • Pink cytoplasm
  • Difference pattern
  • Necrosis
  • High nuclear grade
  • > 5 mitosis / 50 HPF
  • Atypical mitosis
  • Venous invasion
  • Capsular invasion
  • Extra-adrenal invasion
21
Q

This is ___

A

This is adrenal cortical carcinoma

22
Q

This is ___

A

This is adrenal cortical carcinoma

23
Q

Adrenal cortical adenoma is composed of tumor cells similar to ___

A

Adrenal cortical adenoma is composed of tumor cells similar to adrenal cortex

24
Q

Common primary tumors of adrenal medulla are ____, ____, and ____

A

Common primary tumors of adrenal medulla are pheochromocytoma, ganglioneuroma, and neuroblastoma

25
Q

Adrenal medulla is derived from ____ and is composed of ____, ____, and ____

A

Adrenal medulla is derived from neural crest and is composed of pheochromocytes, sustenacular cells, and other stromal cells

26
Q
A
27
Q

Adrenal medulla produces ____

A

Adrenal medulla produces catecholamines

28
Q

Describe syndromes associated with pheochromocytoma

A

Syndromes associated with pheochromocytoma

  • Multiple endocrine neoplasia 2A (MEN 2A)
  • Multiple endocrine neoplasia 2B (MEN 2B)
  • Von Hippel Lindau disease
  • Von Recklinghausen syndrome (NF-1)
  • Sturge-Weber
29
Q

Pheochromocytoma is a tumor of the ____ that produces ____

A

Pheochromocytoma is a tumor of the adrenal medulla that produces catecholamines

30
Q

Pheochromocytoma histology involves ____ and ____

A

Pheochromocytoma histology involves grossly pink / red / grey color and large tumor cells forming nests (Zellballen)

  • Microscopic criteria do not accurately predict the tumor behavior
  • Only definitive criteria for malignancy is metastasis
31
Q

This is ____

A

This is pheochromocytoma

32
Q

Describe gross appearance of pheochromocytoma

A

Pheochromocytoma gross appearance

  • Grey, brown, or red in color
  • Can be heterogeneous cut surface
  • Surrounded by a rim of cortex
33
Q

Pheochromocytoma histological appearance is ____, ____, and ____

A

Pheochromocytoma histological appearance is functional, purple cytoplasm, and sustenacular cells present

  • Difficult to predict malignancy
34
Q

Describe gross and histological appearance of adrenal cortical adenoma

A

Adrenal cortical adenoma gross and histological appearance

  • Gross: golden yellow, homogeneous cut surface, contiguous with cortex
  • Histological: most non-functional, foamy cytoplasm, sustenacular cells absent, malginancy may occur
35
Q

These are ____ and ____ in ____

A

These are zellballen and sustenacular cells in pheochromocytoma

36
Q

Ganglioneuroma is composed of ___ and ___

A

Ganglioneuroma is composed of ganglion cells and schwannoma stroma

  • Derived from neural crest
  • Not hormonally active
37
Q

Neuroblastoma is ____ that most commonly occurs at the ____

A

Neuroblastoma is a malignant tumor of neural crest (neuroblastic) derivation that occurs at the adrenal medulla

  • Mostly children
38
Q

Palpable abdominal mass ± abdominal pain is ____

A

Palpable abdominal mass ± abdominal pain is neuroblastoma

  • Catecholamine metabolites (VMA and HMA) elevated in urine
39
Q

Ganglioneuroma and neuroblastoma exhibit ___

A

Ganglioneuroma and neuroblastoma exhibit different degrees of neuroblastic differentiation

40
Q

Other adrenal lesions typically involve ____

A

Other adrenal lesions typically involve both cortex and medulla

  • Benign conditions: cysts, granuloma, myelolipoma
  • Malignant conditions: metastatic carcinomas, other malignant tumors
41
Q

Most common type of adrenal cyst is ___

A

Most common type of adrenal cyst is vascular / endothelial cyst

42
Q

Adrenal myelolipoma components are ____ and ____

A

Adrenal myelolipoma components are myelo (marrow elements) and lipoma (mature adipose)

  • Grossly: red (marrow) and yellow (fat)
  • Benign tumor of adults
43
Q

Metastatic tumors in the adrenal glands are commonly ___, often ___, and often arise from ___ or ___

A

Metastatic tumors in the adrenal glands are commonly carcinoma, often bilateral, and often arise from renal or lung

  • Can cause adrenal insufficiency
    *
44
Q

Heterotopic / ectopic adrenal cortical tissue is _____ due to _____

A

Heterotopic / ectopic adrenal cortical tissue is normal cortical tissue in an abnormal location due to abnormalities in adrenal cortical cell migration during development

  • Sites: celiac axis (most common), testis, ovary, intra-renal, hernia sacs

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