Presented by Dr. Andres Matoso and prepared by Dr. Yembur Ahmad
75 year old male with an adrenal mass.
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A 75 year old male presents with an adrenal mass. What is your diagnosis?
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Histology: This tumor is composed of nests and cords of cells with eosinophilic and pale cytoplasm and marked degenerative nuclear atypia. There is extensive hemorrhage and thrombus formation that makes for the majority of the mass.
Discussion: This is an example of enlarged adrenal glands where the underlying diagnosis can be masked by a diffusely hemorrhagic process. The most common underlying lesion associated with diffuse hemorrhage are adrenocortical adenomas and benign non-neoplastic adrenal. Carcinomas and other rarer lesions can also show similar findings. Although there is a correlation between adrenocortical malignancy and size, hemorrhage into nonmalignant adrenal glands can result in markedly enlarged adrenals. Around the hemorrhage there is a proliferation of cortical cells with degenerative atypia, so called “endocrine atypia” which is a finding not associated with malignancy.
Histology: This tumor is composed of nests and cords of cells with eosinophilic and pale cytoplasm and marked degenerative nuclear atypia. There is extensive hemorrhage and thrombus formation that makes for the majority of the mass.
Discussion: This is an example of enlarged adrenal glands where the underlying diagnosis can be masked by a diffusely hemorrhagic process. The most common underlying lesion associated with diffuse hemorrhage are adrenocortical adenomas and benign non-neoplastic adrenal. Carcinomas and other rarer lesions can also show similar findings. Although there is a correlation between adrenocortical malignancy and size, hemorrhage into nonmalignant adrenal glands can result in markedly enlarged adrenals. Around the hemorrhage there is a proliferation of cortical cells with degenerative atypia, so called “endocrine atypia” which is a finding not associated with malignancy.
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