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Presented by Jonathan Epstein, M.D. and prepared by Angelique W. Levi, M.D.
Case 2: 41 year old female with 4 cm. adrenal mass
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1. Question
Week 4: Case 2
41 year old female with 4 cm. adrenal mass
Correct
Answer: Pheochromocytoma
Histology: Arising within the adrenal is a tumor characterized by nests of basophilic cells separated by thin walled vessels, typical of many endocrine tumors. Both the nesting pattern (Zellballen) and intense amphophilic granular cytoplasm is characteristic of pheochromocytoma. There is variation in nuclear size and shape with some prominent nucleoli. Malignancy can not be determined based on morphological features, but rather on the presence of metastatic disease. These tumors express neuroendocrine markers, as well as S100 positive dendritic cells draped over the periphery of the tumor nests.
Discussion: Adrenal cortical carcinomas typically have eosinophilic cytoplasm and are considered in a differential of “large pink cell tumors.” Renal cell carcinoma may also have a nesting appearance yet the cytoplasm is typically pale to clear, or eosinophilic and granular. Medullary hyperplasia consists of similar cells, yet medullary hyperplasia is by definition less than 1 cm.
Incorrect
Answer: Pheochromocytoma
Histology: Arising within the adrenal is a tumor characterized by nests of basophilic cells separated by thin walled vessels, typical of many endocrine tumors. Both the nesting pattern (Zellballen) and intense amphophilic granular cytoplasm is characteristic of pheochromocytoma. There is variation in nuclear size and shape with some prominent nucleoli. Malignancy can not be determined based on morphological features, but rather on the presence of metastatic disease. These tumors express neuroendocrine markers, as well as S100 positive dendritic cells draped over the periphery of the tumor nests.
Discussion: Adrenal cortical carcinomas typically have eosinophilic cytoplasm and are considered in a differential of “large pink cell tumors.” Renal cell carcinoma may also have a nesting appearance yet the cytoplasm is typically pale to clear, or eosinophilic and granular. Medullary hyperplasia consists of similar cells, yet medullary hyperplasia is by definition less than 1 cm.
