Difference between revisions of "Adrenals"
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==Adrenal tumors== | ==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>]] | [[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> | <gallery mode=packed heights=200> | ||
File:Adrenal gland Conn syndrome4.jpg|Gross pathology of '''adrenocortical adenoma'''. | 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: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> | </gallery> | ||
+ | |||
+ | ===Other adrenal tumors=== | ||
<gallery mode=packed heights=220> | <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). | 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> | </gallery> | ||
{{Bottom}} | {{Bottom}} |
Revision as of 12:46, 2 July 2020
Author:
Mikael Häggström [note 1]
Contents
Autopsy
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).
Adrenal cortical necrosis. Hemorrhage, fibrin thrombi and short postmortem interval indicate ante-mortem necrosis, otherwise it can be regarded as a postmortem change.[1]
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.
Adrenal tumors
Adenoma versus carcinoma
The most common adrenal tumors are adrenocortical adenomas and carcinomas. These are most commonly distinguished by the Weiss system,[3] as follows:[4]
Characteristic[4] | Score |
---|---|
High nuclear grade (enlarged, oval to lobated, with coarsely granular to hyperchromatic chromatin and easily discernible, prominent nucleoli)[5] | 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:[4]
- 0-2: Adrenocortical adenoma
- 3: Undetermined
- 4-9: Adrenocortical carcinoma
Histopathology of adrenocortical adenoma, most commonly showing clear cells with high lipid contents.[6]
Other adrenal tumors
Notes
- ↑ 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
- ↑ Page 120 in: Rutty, Guy (2001). Essentials of autopsy practice . London New York: Springer. ISBN 978-1-85233-541-0. OCLC 44769560.
- ↑ Data and references for pie chart are located at file description page in Wikimedia Commons.
- ↑ Wang, Cuiping; Sun, Yang; Wu, Huanwen; Zhao, Dachun; Chen, Jie (2014). "Distinguishing adrenal cortical carcinomas and adenomas: a study of clinicopathological features and biomarkers ". Histopathology 64 (4): 567–576. doi: . ISSN 03090167.
- ↑ 4.0 4.1 4.2 Aye, Than Than; Myint, Phone; Myint, Kyar Nyo Soe (2015). "Adrenocortical Oncocytoma Presenting with Gynaecomastia ". Journal of the ASEAN Federation of Endocrine Societies 30 (1): 27–30. doi: . ISSN 08571074.
- ↑ Tito Fojo. Adrenocortical Cancer. Retrieved on 2020-07-02.
- ↑ Mete, Ozgur; Duan, Kai (2018). "The Many Faces of Primary Aldosteronism and Cushing Syndrome: A Reflection of Adrenocortical Tumor Heterogeneity
". Frontiers in Medicine 5. doi: . ISSN 2296-858X.
Attribution 4.0 International (CC BY 4.0) license
Image sources