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Adrenocortical Adenoma

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  • Functional and can differentiate to any of the three 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

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  • Histology:
    • Recapitulate any of the three 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+