|
RESIDENT
CASE
STUDIES
August 21,
2003: Case 4 Table
of Contents | List
of Diagnoses | Case 1 | Case 2 |
Case
3 | Case 4
Middle aged female with a 10cm adrenal
mass. (scrape prep)
Discussion by Zach Ellis, MD
Malignant neoplasm of the adrenal cortex
that may be hormonally active.
Gross Appearance:
By CT scan adrenal carcinoma is more likely to be greater than 6 cm. in
diameter. this malignancy may be hormonally active, especially virilizing.
Malignancy is suggested by CT scan if the borders are irregular and the
signal is inhomogeneous
Microscopic
Appearance:
- There is significant cytological overlap
between benign and malignant neoplasms of he adrenal cortex.
- On FNA, the cells are poorly cohesive
with single cells, crowded clusters and irregular arrangements.
- Either lesion can range from bland
appearing lipid laden cells with abundant cytoplasm and granular
nuclei with prominant nucleoli to anaplstic cells.
- Malignancy is suggested by a necrotic
background and atypical mitoses are diagnostic of carcinoma
Diagnostic Criteria
- Lipid laden cells
- Granular nucleus with prominant
nucleolus
- Poorly cohesive
- Necrotic background
- Atypical mitoses
Immunostains:
- Vim+, CK+/-, S-100+/-, Synap+/-,
Chromo-, AFP-, CEA-
Differential Diagnosis:
- Renal cell carcinoma
- Pheochromocytoma
- Metastatic carcinoma
- Adrenal adenoma
- Lymphoma
References:
- Demay, RM. (1996). The Art and Science of Cytopathology. Chicago, IL: American Society for Clinical Pathology Press.
- Stephen S Sternberg et al. (Eds): Diagnostic surgical pathology, Volume 1, 3rd edition. Lippincott William & Wilkins.
|
