Adrenals

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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. 
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Image sources