Adrenals: Difference between revisions

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{{Comprehensiveness}}
==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]]'''.  
*{{Comprehensive-begin}}Remove the adrenals, trim them from excessive adherent fat, and weight them. Their combined  weight in an adult human ranges from 7 to 10&nbsp;grams.<ref>{{cite book|last1=O'Hare|first1=A. Munro Neville, Michael J.|title=The Human Adrenal Cortex Pathology and Biology – An Integrated Approach|date=1982|publisher=Springer London|isbn=9781447113171|pages=Chapter 4: Structure of the adult cortex}}</ref>{{Comprehensive-end}}


<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>


===Autopsy report===
===Autopsy report===
Normal status:
Normal status can be described as either:
*Minimal: Adrenal glands are normal bilaterally.
*Adrenal glands are normal bilaterally.
*Moderate length: Adrenal glands are ordinarily configured and with no definable focal changes on cut surfaces.
*{{Moderate-begin}}Adrenal glands are ordinarily configured and with no definable focal changes on cut surfaces.{{Moderate-end}}
 
*{{Comprehensive-begin}}The adrenals are normal in size, shape and consistency, with a weight of __ grams on the right and __ grams on the left. The cortices are orange with <normal / increased / decreased thickness>. The medullae are <grey / autolyzed>.{{Comprehensive-end}}
==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}}

Latest revision as of 12:35, 30 January 2021

Author: Mikael Häggström [note 1]

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

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.
  • ((Remove the adrenals, trim them from excessive adherent fat, and weight them. Their combined weight in an adult human ranges from 7 to 10 grams.[1]))

Autopsy report

Normal status can be described as either:

  • Adrenal glands are normal bilaterally.
  • (Adrenal glands are ordinarily configured and with no definable focal changes on cut surfaces.)
  • ((The adrenals are normal in size, shape and consistency, with a weight of __ grams on the right and __ grams on the left. The cortices are orange with <normal / increased / decreased thickness>. The medullae are <grey / autolyzed>.))

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. ↑ O'Hare, A. Munro Neville, Michael J. (1982). The Human Adrenal Cortex Pathology and Biology – An Integrated Approach . Springer London. pp. Chapter 4: Structure of the adult cortex. ISBN 9781447113171. 
  2. ↑ Page 120 in: Rutty, Guy (2001). Essentials of autopsy practice . London New York: Springer. ISBN 978-1-85233-541-0. OCLC 44769560. 

Image sources


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