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>]]
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===Adenoma versus carcinoma===
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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>
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{|class="wikitable"
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! 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
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|-
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| 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
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|-
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| More mitoses than 5/50 high power fields || 1
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|-
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| Atypical mitoses || 1
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|-
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| Eosinophilic cytoplasm in >75% of tumor cells || 1
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|-
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| Diffuse architecture of >33% of tumor || 1
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|-
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| Necrosis || 1
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|-
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| Venous invasion || 1
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|-
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| Sinusoidal invasion (no smooth muscle in wall) || 1
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|-
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| Capsular invasion || 1
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|}
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Total score indicates:<ref name="AyeMyint2015"/>
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*0-2: Adrenocortical adenoma
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*3: Undetermined
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*4-9: Adrenocortical carcinoma
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<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>
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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.
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File:Histopathology of adrenocortical carcinoma.jpg|Histopathology of '''adrenocortical carcinoma''', with marked mitotic activity with atypical forms.
 
</gallery>
 
</gallery>
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===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]

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).

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

Incidences and prognoses of adrenal tumors.[2]

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

Other adrenal tumors

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. 
  2. Data and references for pie chart are located at file description page in Wikimedia Commons.
  3. 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:10.1111/his.12283. ISSN 03090167. 
  4. 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:10.15605/jafes.030.01.08. ISSN 08571074. 
  5. Tito Fojo. Adrenocortical Cancer. Retrieved on 2020-07-02.
  6. 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:10.3389/fmed.2018.00054. ISSN 2296-858X. 
    Attribution 4.0 International (CC BY 4.0) license

Image sources