Difference between revisions of "Adrenals"

From patholines.org
Jump to navigation Jump to search
(→‎Autopsy processing: +Congestion)
(6 intermediate revisions by the same user not shown)
Line 3: Line 3:
 
|author2=
 
|author2=
 
}}
 
}}
 +
 +
==Main targets==
 +
<gallery>
 +
File:Adrenal gland Conn syndrome4.jpg|link=Adrenal tumors|'''[[Adrenal tumors]]'''
 +
</gallery>
  
 
==Autopsy==
 
==Autopsy==
 
===Autopsy processing===
 
===Autopsy processing===
*In [[autopsy]], make a couple of cuts through the adrenal glands, such as transversal ones, and look mainly for tumors (see separate section below).  
+
In [[autopsy]], make a couple of cuts through the adrenal glands, such as transversal ones, and look mainly for '''[[adrenal tumors]]'''. A comprehensive approach is to remove the adrenals, trim them from excessive adherent fat, and weight them.
  
 
<gallery mode=packed heights=220>
 
<gallery mode=packed heights=220>
 
File:Histopathology of adrenal cortical necrosis.jpg|Adrenal '''cortical necrosis'''. Hemorrhage, fibrin thrombi and short postmortem interval indicate ante-mortem necrosis, otherwise it can be regarded as a postmortem change.<ref>[https://books.google.se/books?id=DuNTznUH8ZkC&pg=PA120 Page 120] in: {{cite book | last=Rutty | first=Guy | title=Essentials of autopsy practice | publisher=Springer | publication-place=London New York | year=2001 | isbn=978-1-85233-541-0 | oclc=44769560 | ref=harv}}</ref>
 
File:Histopathology of adrenal cortical necrosis.jpg|Adrenal '''cortical necrosis'''. Hemorrhage, fibrin thrombi and short postmortem interval indicate ante-mortem necrosis, otherwise it can be regarded as a postmortem change.<ref>[https://books.google.se/books?id=DuNTznUH8ZkC&pg=PA120 Page 120] in: {{cite book | last=Rutty | first=Guy | title=Essentials of autopsy practice | publisher=Springer | publication-place=London New York | year=2001 | isbn=978-1-85233-541-0 | oclc=44769560 | ref=harv}}</ref>
 +
File:Histopathology of adrenal congestion.jpg|Adrenal '''venous congestion''' in circulatory failure.
 
</gallery>
 
</gallery>
  
Line 17: Line 23:
 
*Moderate length: Adrenal glands are ordinarily configured and with no definable focal changes on cut surfaces.
 
*Moderate length: Adrenal glands are ordinarily configured and with no definable focal changes on cut surfaces.
  
==Adrenal tumors==
 
[[File:Incidences and prognoses of adrenal tumors.png|thumb|280px|Incidences and prognoses of adrenal tumors.<ref>Data and references for pie chart are located at [https://commons.wikimedia.org/wiki/File:Incidences_and_prognoses_of_adrenal_tumors.png file description page in Wikimedia Commons.]</ref>]]
 
 
===Adenoma versus carcinoma===
 
The most common adrenal tumors are adrenocortical adenomas and carcinomas. These are most commonly distinguished by the Weiss system,<ref name="WangSun2014">{{cite journal|last1=Wang|first1=Cuiping|last2=Sun|first2=Yang|last3=Wu|first3=Huanwen|last4=Zhao|first4=Dachun|last5=Chen|first5=Jie|title=Distinguishing adrenal cortical carcinomas and adenomas: a study of clinicopathological features and biomarkers|journal=Histopathology|volume=64|issue=4|year=2014|pages=567–576|issn=03090167|doi=10.1111/his.12283}}</ref> as follows:<ref name="AyeMyint2015">{{cite journal|last1=Aye|first1=Than Than|last2=Myint|first2=Phone|last3=Myint|first3=Kyar Nyo Soe|title=Adrenocortical Oncocytoma Presenting with Gynaecomastia|journal=Journal of the ASEAN Federation of Endocrine Societies|volume=30|issue=1|year=2015|pages=27–30|issn=08571074|doi=10.15605/jafes.030.01.08}}</ref>
 
{|class="wikitable"
 
! Characteristic<ref name="AyeMyint2015">{{cite journal|last1=Aye|first1=Than Than|last2=Myint|first2=Phone|last3=Myint|first3=Kyar Nyo Soe|title=Adrenocortical Oncocytoma Presenting with Gynaecomastia|journal=Journal of the ASEAN Federation of Endocrine Societies|volume=30|issue=1|year=2015|pages=27–30|issn=08571074|doi=10.15605/jafes.030.01.08}}</ref> !! Score
 
|-
 
| High nuclear grade (enlarged, oval to lobated, with coarsely granular to hyperchromatic chromatin and easily discernible, prominent nucleoli)<ref>{{cite web|url=https://oncohemakey.com/adrenocortical-cancer/|title=Adrenocortical Cancer|author=Tito Fojo|accessdate=2020-07-02}}</ref> || 1
 
|-
 
| More mitoses than 5/50 high power fields || 1
 
|-
 
| Atypical mitoses || 1
 
|-
 
| Eosinophilic cytoplasm in >75% of tumor cells || 1
 
|-
 
| Diffuse architecture of >33% of tumor || 1
 
|-
 
| Necrosis || 1
 
|-
 
| Venous invasion || 1
 
|-
 
| Sinusoidal invasion (no smooth muscle in wall) || 1
 
|-
 
| Capsular invasion || 1
 
|}
 
Total score indicates:<ref name="AyeMyint2015"/>
 
*0-2: Adrenocortical adenoma
 
*3: Undetermined
 
*4-9: Adrenocortical carcinoma
 
 
<gallery mode=packed heights=200>
 
File:Adrenal gland Conn syndrome4.jpg|Gross pathology of '''adrenocortical adenoma'''.
 
File:Histopathology of adrenocortical adenoma.jpg|Histopathology of '''adrenocortical adenoma''', most commonly showing clear cells with high lipid contents.<ref>{{cite journal|last1=Mete|first1=Ozgur|last2=Duan|first2=Kai|title=The Many Faces of Primary Aldosteronism and Cushing Syndrome: A Reflection of Adrenocortical Tumor Heterogeneity|journal=Frontiers in Medicine|volume=5|year=2018|issn=2296-858X|doi=10.3389/fmed.2018.00054}}<br>Attribution 4.0 International (CC BY 4.0) license</ref>
 
File:Adrenal cortical carcinoma.JPG|Gross pathology of '''adrenocortical carcinoma'''. They are generally large, with a tan-yellow cut surface, and often have areas of hemorrhage and necrosis.
 
File:Histopathology of adrenocortical carcinoma.jpg|Histopathology of '''adrenocortical carcinoma''', with marked mitotic activity with atypical forms.
 
</gallery>
 
 
===Other adrenal tumors===
 
<gallery mode=packed heights=220>
 
File:Histopathology of a pheochromocytoma with coagulative necrosis, annotated.jpg|Histopathology of a '''pheochromocytoma''' with coagulative necrosis, displayed at gross pathology (upper left) and light microscopy at low (upper right), medium (lower left) and high magnification (lower right).
 
</gallery>
 
 
{{Bottom}}
 
{{Bottom}}

Revision as of 10:42, 21 July 2020

Author: Mikael Häggström [note 1]

Main targets

Autopsy

Autopsy processing

In autopsy, make a couple of cuts through the adrenal glands, such as transversal ones, and look mainly for adrenal tumors. A comprehensive approach is to remove the adrenals, trim them from excessive adherent fat, and weight them.

Autopsy report

Normal status:

  • Minimal: Adrenal glands are normal bilaterally.
  • Moderate length: Adrenal glands are ordinarily configured and with no definable focal changes on cut surfaces.

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. Page 120 in: Rutty, Guy (2001). Essentials of autopsy practice . London New York: Springer. ISBN 978-1-85233-541-0. OCLC 44769560. 

Image sources