Diagnostic dilemmas in enlarged and diffusely hemorrhagic adrenal glands.

Abstract

We have noted an increasing number of cases of enlarged adrenal glands where the underlying diagnosis was masked by a diffusely hemorrhagic process. We identified from our database 59 cases (32 consults, 27 routine) of adrenal glands with diffuse (>25%) hemorrhage received between 2000 and 2014. Fifty-three adrenalectomies and 6 biopsies were identified. The diagnoses after central review were 41 adrenocortical adenomas, 1 nodular adrenocortical hyperplasia with associated myelolipoma, 1 benign adrenocortical cyst, and 10 nonneoplastic adrenal glands with hemorrhage. A definitive diagnosis for the 6 biopsies was precluded by the sample size. The adrenocortical adenomas (size, 1-13 cm; 25%-95% hemorrhage) showed clear cell change in the neoplastic area (10%-80% of the tumor), 19 showed focal calcification (1 with ossification), 11 showed areas of papillary endothelial hyperplasia, 10 showed scattered lymphoplasmacytic inflammation, 6 showed benign cortical tissue extending beyond the adrenal capsule into soft tissue, 1 showed necrosis in the form of ghost cells, 2 showed lipomatous change, and 6 were associated with incidental benign lesions (1 cortical cyst, 1 schwannoma, and 4 myelolipomas). Twenty-four of the adrenocortical adenomas were consults where the referring pathologist had trouble classifying the lesion. Of the 10 nonneoplastic adrenals (4.5-22 cm; 40%-80% hemorrhage), 2 were consults. In summary, pathologists have difficulties recognizing adrenocortical adenomas in the setting of a massively enlarged and hemorrhagic adrenal gland. Although there is a correlation between adrenocortical malignancy and size, hemorrhage into nonmalignant adrenal glands can result in markedly enlarged adrenals.

• Authors: Mairo L Diolombi, Francesca Khani, Jonathan I Epstein
• Journal: Human pathology (Hum Pathol) Vol. 53 Pg. 63-72 (07 2016) ISSN: 1532-8392 [Electronic] United States
• PMID: 27001431 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Topics

• Adrenal Cortex Neoplasms (pathology)
• Adrenal Gland Diseases (pathology)
• Adrenal Gland Neoplasms (pathology)
• Adrenal Glands (pathology)
• Adrenocortical Adenoma (pathology)
• Adult
• Aged
• Aged, 80 and over
• Biopsy
• Cysts (pathology)
• Databases, Factual
• Diagnosis, Differential
• Female
• Hemorrhage (pathology)
• Humans
• Hypertrophy
• Male
• Middle Aged
• Myelolipoma (pathology)
• Necrosis
• Predictive Value of Tests
• Prognosis
• Tumor Burden