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Pathology for Urologists

Adrenocortical Adenoma


Image A
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Image B
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  • Functional and can differentiate to any of the 3 layers of cortex.
  • Non-functional also common, seen in 25% autopsy.
  • Results to overproduction of corticosteroids (Cushing syndrome), aldosterone (Conn syndrome), and sex hormones (adrenogenital syndrome).
  • Often unilateral.
  • Gross:
    • Usually solitary lesions, well-encapsulated, cut surface is yellow-tan (image A).
    • Can be black heavily pigmented, for black adenomas (image B).
  • Adenomas generally measure <5 cm and weigh <50 g; tumors >100gm should be examined for malignancy.

Image C
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Image D
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  • Histology:
    • Recapitulate any of the 3 cortical layers (image C).
    • Bizarre nuclei may be seen but mitoses are exceptionally rare or absent
    • May contain foci of myelolipoma, manifested by the presence of bone marrow elements
  • Variations:
    • Aldosterone-omas: Golden yellow color with targetoid "spironolactone" bodies (lamellated eosinophilic inclusions treated with spironolactone).
    • Black adenomas: Have dark brown/ black color due to the presence of lipofuscin pigment (image D); may be associated with primary aldosteronism or Cushing's syndrome
    • Oncocytic Adenoma: Highly eosinophilic cytoplasm due to numerous mitochondria.
  • Immunohistochemistry: inhibin+, calretinin+ and MelanA+.
  • DDX: (more often in core biopsy)
    • Clear cell RCC: have optically clear cytoplasm and keratin+ and CAIX+.

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