A Diagnostic Approach to Adrenal Cortical Lesions

Abstract

The adrenal gland is not a common specimen in surgical pathology practice as, until recently, adrenal tumors were recognized in life only if associated with hypersecretion of hormones or evidence of malignancy. However, adrenal nodules are not uncommon at autopsy, and the number of these found in life is now increasing as they are identified when the abdomen is scanned for the investigation of other diseases using computed tomography or magnetic resonance imaging. It is therefore becoming increasingly important for the surgical pathologist to be aware of the range of pathology in the gland and to understand how to approach the specimens. This short review will deal with lesions of the adrenal cortex.

Giant adrenal myelolipoma

“…The aetiology of myelolipomas in general is unknown. Recent experimental evidence suggests that both the myeloid and lipomatous elements have a monoclonal origin, which strongly supports the hypothesis that myelolipomas are neoplastic lesions 9 . Malignant degeneration of myelolipomas has not been reported so far 10 …”

Concurrent pheochromocytoma and cortical carcinoma of the adrenal gland

“…The Ki-67 index was high (>4%; Fig. 1) [2]. Capsular and vascular invasion could not be assessed due to sample fragmentation.…”

“…There was neither necrosis nor broad collagen bands. Immunostaining of this second cell population was positive for inhibin a (1:25, Dako) and CD56 (1:100, Novocastra, Newcastle-upon-Tyne, UK), and negative for chromogranin A (1:100, Dako), synaptophysin (1:200, Dako), S100 (1:1,000, Dako), serotonin (1:100, Dako), somatostatin (1:800, Dako), CK7 (1:100, Novocastra), and CK20 (1:50, Dako) [2]. The Ki-67 index was high (>4%; Fig.…”

MicroRNA expression patterns in adrenocortical carcinoma variants and clinical pathologic correlations

“…An inter-observer validation study recently showed that the Reticulin Algorithm, previously proposed as a diagnostic approach alternative to the Weiss System, is highly accurate and reproducible to define malignancy also in adrenocortical carcinoma special histotypes [6]. However, while the morphological distinctiveness of myxoid and oncocytic variant has already been thoroughly characterized and reviewed [7][8][9][10], their immunohistochemical and molecular phenotype has been addressed so far by very few studies only [8,[10][11][12][13].…”