Adrenal tumors

OSHAN SHRESTHA
MBBS, MD
18TH MARCH, 2024
Adrenal cortical
adenoma
 Introduction

 Benign epithelial neoplasm of adrenal cortical cells

 Usually unilateral and solitary

 May be active or silent and discovered incidentally

 Gross morphology

 Usually solitary, well-circumscribed tumour

 Measuring ≤50 mm

 Aldosterone producing adenomas have a yellow-gold

colour due to prominent lipid rich clear cells
 Microscopy

 Circumscribed and cellular with abundant vasculature

 Lipid rich vacuolated cells to compact lipid poor cells with
eosinophilic cytoplasm

 Cells organized in nests or cords

 Low/absent mitosis, no necrosis
Adrenal cortical
carcinoma
 Introduction

 Malignant epithelial tumour from adrenal cortical cells

 Adrenal virilization-feminization syndrome with adrenal mass:

Indicative of malignancy

 Adrenal Cushing syndrome can also occur

 Pediatric as well as elderly age group
 Morphology-Gross

 Large, unilateral, solitary heterogenous tumours

 Median size: 8-10 cm

 Cut surface: Yellowish-tan variegated appearance, with

nodularity
 Necrosis and haemorrhage frequent in high-grade tumours
 Microscopy

 Invasive (angioinvasion, capsular invasion, local invasion)

 Solid, broad trabecular, or large nested growth

 Increased mitosis >5 per 10mm2

 Punctate/comedo-type or geographic necrosis frequently
seen in high-grade carcinomas
Phaeochromocytoma
 Introduction

 Malignant neuroendocrine neoplasm

 Originates from chromaffin cells of the adrenal medulla

 Can synthesize catecholamines with most frequent

manifestation being hypertension
 Headache, palpitations and diaphoresis
 Morphology-Gross:

 Circumscribed mass compressing the adrenal capsule

 Tumour diameter ~3 - 5 cm, but may exceed 10 cm
 Cut surface is pink-grey to tan

 Haemorrhage, cystic change and fibrosis in larger tumors

 Microscopy

 “Zellballen” pattern most common, consisting nests of tumour

cells separated by peripheral capillaries
 Basophilic to amphophilic granular cytoplasm
 Nuclear pseudoinclusions often present
 Rare mitosis
Neuroblastoma
 Introduction

 Peripheral neuroblastic tumour of neural crest origin

 >40% of tumours found in the adrenal medulla
 Other sites: Abdomen (25%), posterior mediastinum (15%),
pelvic cavity (5%), neck (~3-5%)
 Most common neoplasms during the first year of life
(90% < 5 years of age)
Morphology-Gross

 Soft, grey-tan mass (often haemorrhagic), with or without foci

of necrosis
 Can reach 10 to 100 mm
 Can be well encapsulated or show invasive growth into the
surrounding tissue
 Microscopy

Poorly differentiated subtype (~89% of neuroblastomas):

 Readily detectable neurites, +/- Homer Wright rosette

 <5% of neuroblasts have differentiation towards mature
neurons
 Neuroblasts have salt-and-pepper appearance chromatin