Presented by Dr. Andres Matoso and prepared by Dr. Yembur Ahmad
46 year old female with an adrenal mass
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1. Question
A 46 year old female presents with an adrenal mass. What is the diagnosis?
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Correct answer: D
Histology: This tumor is composed of nests and cords of highly atypical cells with eosinophilic cytoplasm replacing the entire adrenal parenchyma.
Discussion: The adrenal gland is one of the most common sites for metastatic carcinoma from lung, kidney, colon and involvement by melanoma and lymphoma. The differential diagnosis also includes primary adrenal lesions including adrenocortical neoplasia and pheochromocytomas. Adrenocortical carcinomas are rare while metastases are more common in the older patients. Immunohistochemistry can help in the differential diagnosis; adrenocortical neoplasias are usually negative or only focally positive for broad spectrum cytokeratins, while they are positive for inhibin, calretinin and SF1. Both pheochromocytomas and adrenocortical carcinomas can stain for synaptophysin, but staining for chromogranin makes pheochromocytoma more likely. Still, when expression of neuroendocrine markers is present, one should not forget that metastatic tumors can also express neuroendocrine markers, and therefore other organ specific markers should be included in the panel based on the morphologic features of the lesion and the past medical history of the patient.
Histology: This tumor is composed of nests and cords of highly atypical cells with eosinophilic cytoplasm replacing the entire adrenal parenchyma.
Discussion: The adrenal gland is one of the most common sites for metastatic carcinoma from lung, kidney, colon and involvement by melanoma and lymphoma. The differential diagnosis also includes primary adrenal lesions including adrenocortical neoplasia and pheochromocytomas. Adrenocortical carcinomas are rare while metastases are more common in the older patients. Immunohistochemistry can help in the differential diagnosis; adrenocortical neoplasias are usually negative or only focally positive for broad spectrum cytokeratins, while they are positive for inhibin, calretinin and SF1. Both pheochromocytomas and adrenocortical carcinomas can stain for synaptophysin, but staining for chromogranin makes pheochromocytoma more likely. Still, when expression of neuroendocrine markers is present, one should not forget that metastatic tumors can also express neuroendocrine markers, and therefore other organ specific markers should be included in the panel based on the morphologic features of the lesion and the past medical history of the patient.
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