WSI23-12: Endocrine
From MGH Learn Pathology
Request details
- Request type Study
- Subspecialty Head and Neck
- Set ENT Pathology
- Topic Endocrine
- Presenter Sadow, Peter M.,MD, PhD
- Date and time Wednesday, June 19, 2024 12:00 PM
Toggle columns: Diagnosis
Case | Clinical history | Requester | Diagnosis |
---|---|---|---|
Case | Clinical history | Requester | Diagnosis |
| 54 year old female | Si787 | Granulomatous thyroiditis possibly associated with deQuervain's thyroiditis or a drug reaction |
| 44 year old female | Si787 | PTC • encapsulated follicular variant with clear cell morphology |
| 36 year old female | Si787 | PTC • encapsulated follicular variant • minimally invasive (5.0 cm) • intrathyroidal |
| 40 year old female with a circumscribed 5.1 cm right thyroid lobe mass suspicious for malignancy (papillary thyroid carcinoma) by FNA cytology biopsy • initially diagnosed as papillary thyroid carcinoma • follicular variant | Si787 | Follicular thyroid adenoma (5.1 cm); differential diagnosis includes FT-UMP • NIFTP • WDT-UMP and invasive encapsulated follicular variant of papillary thyroid carcinoma |
| 41 year old male | Si787 | PTC • classical type (3.1 cm) • encapsulated. |
| 72 year old male | Si787 | Papillary thyroid microcarcinoma (<0.1 cm) |
| 69 year old female | Si787 | PTC • clear cell type |
| 63 year old female | Si787 | Predominantly microfollicular adenomatous nodule |
| 22 year old female | Si787 | PTC • tall cell variant |
| 23 year old female | Si787 | PTC • tall cell variant |
| 26 year old female | Si787 | PTC • diffuse sclerosing variant |
| 51 year old female | Si787 | Ciliated respiratory epithelial-lined inclusion cyst (1.1 cm) • benign |
| 61 year old male | Si787 | PTC • classical type |
| 40-year-old-female with 2.1 cm well-circumscribed mass. | Si787 | Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP); positive for HBME1 and negative for BRAF |
| 83 year old female | Si787 | Enlarged (1.8 g) hypercellular parathyroid with marked reduction in intracellular fat |
| 68 year old female | Si787 | Minimally invasive follicular thyroid carcinoma • oncocytic type |
| 72 year old female | Si787 | Hurthle cell adenoma with metastatic endometrial adenocarcinoma. Papillary thyroid microcarcinoma. |
| 61 year old male | Si787 | PTC • classical type |
| 18 year old female | Si787 | PTC • oncocytic variant (4.8 cm) |
| 22 year old female | Si787 | PTC • tall cell variant |
| 26 year old female | Si787 | Metastatic papillary thyroid carcinoma |
| 55 year old female | Si787 | Minimally invasive follicular thyroid carcinoma |
| 49 year old female | Si787 | PTC • encapsulated follicular vairant with focal calcification (2.2 cm) • intrathyroidal |
| 68 year old female with visual disturbance and expressive aphasia | Si787 | Undifferentiated (anaplastic) thyroid carcinoma. Frameshif mutation PTEN and P53 |
| 34 year old female | Si787 | Hyalinizing trabecular tumor (0.9 cm) negative for malignancy |
| 47 year old male with right thyroid mass with history of XRT and chemotherapy 29 and 27 years ago • respectively for initial and recurrent Hodgkin lymphoma | Si787 | High grade mucoepidermoid carcnoma (at least 2.2 cm) + ETE • + PN1 |
| 39 year old female | Si787 | PTC • hobnail variant |
| 48 year old female with left sided thyroid mass noted by her gyn | Si787 | PTC • classical type with Hobnail features and squamous metaplasia. + LVI • + multiple nodes |
| 46 year old male with 2.1 cm mass in the right thyroid lobe with numerous mets to mediastinum and neck nodes | Si787 | Medullary thyroid carcinoma met 30/34 R necknodules and mediastinum |
| 64 year old female who presents 2+ months prior with "lump in her throat" and associated discomfort • including hoarseness and dysphagia with pills | Si787 | Poorly differentiated thyroid carcinoma (7.1 cm) arising in association with PTC with PTC LN metastasis |
| 66 year old male with large thyroid mass | Si787 | Undifferentiated (anaplastic) thyroid carcinoma arising in association with PTC • classical variant |
| 72 year old female with prior XRT for endometrial cancer now with a thyroid mass | Si787 | Hurthle cell adenoma (2.9 cm) with metastatic endometrioid endometrial carcinoma • intralesional |
| 53 year old female with dysphagia and mass occupying the left lobe of the thyroid | Si787 | Paranganglioma |
| 49 year old female with treatment refractory Graves disease | Si787 | Graves disese -- diffuse nodular papillary hyperplasia |
| 50 year old male with h/o tall cell papillary thyroid carcinoma with bulky neck disease | Si787 | Metastatic undifferentiated (anaplastic) thyroid carcinoma |
| 53 year old male with thyroid fullness • assymptomatic • noted on physical exam by PCP at routine visit | Si787 | Medullary thyroid carcinoma with dominant 1.2 cm L mass. + LVI • + mult mets (neck) • + margin. Surgery with amplifications post-op increased calcitonin |
| 87 year old female with left superior aspect thyroid mass | Si787 | MTC (1.7 cm) |
| 88 year old female with SOB • and difficulty swallowing - 1 yr ultrasound shows L-sided thyroid mass | Si787 | PTC • Warthin tumor-like variant (5.8 cm) with LVI. |
| 30 year old male with enlarged thyroid and hyperthyroidism | Si787 | Multinodular papillary hyperplasia c/w Graves disease |
| 19 year old female with thyroid cancer | Si787 | PTC • diffuse sclerosing variant with bulky left-sided nodal involvement |
| 64 year old male with large • left lower aspect thyroid mass | Si787 | PTC (1.5 cm) with oncocytic and hobnail features |
| 65 year old male with elevated TSH which prompted U/S - 5.5 cm left thyroid mass with enlarged lymph nodes | Si787 | Squamous cell carcinoma of the thyroid (7.1 cm) with extrathyroidal extension pT4a NO MX (AJCC 7th ed) |
| 72 year old female noticed a lump in her neck with thyroidectomy performed four months later for follicular neoplasm | Si787 | Angioinvasive follicular thyroid carcinoma (2.6 cm) R completely excised with focal LVI and capsular invasion |
| 62 year old woman with significant past medical history presents with a multinodular thyroid and 1.8 cm dominant right-sided mass called + neoplastic cells on FNA | Si787 | Metastatic leiomyosarcoma (1.8 cm) nodular Hashimoto thyroiditis. h/o leiomyosarcoma of uterus with lung metastasis |
| Cleveland Clinic - 59 year old female with 3.3 cm neck mass | Si787 | PTC • columnar cell variant |
| 81 year old male with biopsy (outside) of thyroid + papillary thyroid carcinoma | Si787 | Extranodal marginal zone lymphoma (MALT-type) arising in a background of profound chronic lymphocytic (Hashimoto) thyroiditis with a dominant 2.1 cm nodule with necrosis (likely oncocytic and likely what was erroneously called PTC earlier]) |
| 54 year old female with right thyroid mass | Si787 | Benign cyst (3.8 cm) - not this slide. Papillary thyroid microcarcinoma (0.2 cm) arising in a mixed micro and macrofollicular adenoma (0.8 cm) |
| 55 year old male with left thyroid nodule | Si787 | Medullary thyroid carcinoma (1.1 cm) |
| 41 year old female with follicular lesion with atypia of right thyroid lobe | Si787 | Follicular adenoma (oncocytic) with oncocytic atypia. Two microcarcinomas. Micro HBME • galectin + • Adenoma HBME • galectin - |
| 14 year old female with 5.5 cm cystic lesion of the thyroid | Si787 | Bronchogenic cyst |
| 38 year old female with Hashimoto thyroiditis and bilateral thyroid nodules | Si787 | Hyalinizing trabecular tumor (0.8 cm) |
| 48 year old female with bilateral neck disease and bilateral thyroid lesions | Si787 | PTC • classical type with osseous metaplasia • two foci 1.7 and 1.3 cm. +BRAF both |
| 21 year old female 5.8 cm mass replascing thyroid with evidence of esophageal involvement and multiple lymph nodes involved • including mediastinal | Si787 | PTC • diffuse sclerosing variant |
| 22 year old with effaced left thyroid lobe and lymph adenopathy | Si787 | PTC • multifocal with fx of diffuse sclerosing variant • involving the majority of the left lobe • lower aspect of R lobe with extrathyroidal extension • invasion of adjacent parathyroid • positive margins • LVI and bilateral LN involvemennt |
| 26 year old female with bilateral thyroid nodules | Si787 | PTC • diffuse sclerosing variant |
| 13 year old female with thyroid follicular nodular disease and hypothyroidism | Si787 | Diffuse sclerosing papillary thyroid carcinoma with LVI • + margins • + gross ETE • invasion of thymus • + mult + LN; CCDC6::RET |
| 66 year old female with thyroid mass | Si787 | PTC • oncocytic variant with tall cell featrures (1.9 cm) 0.7 cm 2nd focus same morphology. BRAFVE + |
| 51 year old male with left lobe lesion | Si787 | Atypical folliculra adenoma with a pronounced trabecular growth pattern (2.6 cm) |
| 44 year old female with multiple thyroid nodules and a dominant • calcified 0.9 cm nodule | Si787 | Multiple solid • microfollicular adenomatous nodules raise the possibility of Cowden syndrome |
| 34 year old female with 4.8 cm nodule left lobe | Si787 | Papillary thyroid carcinoma • macarofollicular |
| 62 year old male with right thyroid cyst | Si787 | Benign unilocular epithelial cyst |
| 73 year old with central neck mass s/p 3 surgeries | Si787 | Poorly differentiated carcinoma involving peritracheal ST • met PTC hobnail variant to LN and PDL as well in LN |
| 52 year old female with h/o mitral regurgitation • hematuria • anxiety • and endometriosis. Right-sided (thyroid) disese with bulky lymphadenopathy • possibley with nerve involvement - right lobectomy (FNA called PTC) | Si787 | Medullary thyroid carcinoma (7.0 cm) extrathyroidal • + margin lymph node mets |
| 79 year old male who presents with changes in phonation and a thyroid mass | Si787 | PTC with high-grade features and foci of undifferentiated carcioma with PTC in lymph node mets |
| 82 year old who presents with hoarseness | Si787 | Undifferentiated (anaplastic) thyroid carcinoma • osteoclast-like variant arising in association with poorly differentiated carcinoma and oncocytic follicular carcinoma presents with lung mets as well |
| 73 year old female with suspicious thyroid nodules with total thyroidectomy | Si787 | Atypical oncocytic neoplasm (adenoma) • 1.8 cm |
| 70 year old female presented with severe chest tightness • shortness of breath and afib in Oct. 2008. U/S showed 5.7 left thyroid mass but b/L nodules and LAD CT showed multiple lung nodules | Si787 | Undifferentiated (anaplastic) carcnoma of the thyroid 7.4 cm with extensive ETE to skeletal muscle and ST and large vessels. + LNs |
| 62 year old male with widely metastatic renal cell carcinoma who presents with a thyroid mass with tracheal invasion on routine f/u | Si787 | Metastatic renal cell carcinoma • invaisve through tracheal cartilage and involving both tracheal mucosa and peritracheal soft tissue with LVI. High gradepapillary thyroid carcinoma • colliding with RCC at the junction of the tracheal cartilage with extensive LVI. |
| 15 year old female with non-toxic multinodular goiter | Si787 | Atypical papillary hyperplastic lesion with oncocytic features (1.6 cm) • intrathyroidal |
| 60 year old male with h/o thyroid nodules in 1980s s/p L excision for benign lesion. Now with b/L nodules and L lobectomy | Si787 | Benign lymphoepithelial cysts (1.8 and 1.0 cm). Fibrotic • lobultaed degenerative area 1.1 cm. TINEN. |
| 35 year old female with circumscribed left lobe thyroid nodule | Si787 | Mixed micro and macrofollicular adenoma with hyperplastic changes and focal nuclear atypia |
| 70 year old female with bilateral thyroid nodules | Si787 | Papillary thyroid microcarcinoma. Pigmented with clear cell change. |
| 25 year old female with thyroid mass and lymphadenopathy | Si787 | PTC • diffuse sclerosing variant with LVI • extrathyroidal extension • and lymph node mets |
| 61 year old male with Graves disease and a thyroglossal duct cyst | Si787 | PTC with features of Warthin-like variant and tall cell variant in the setting of florid Graves disease |
| 38 year old female with thyroglossal duct cyst | Si787 | PTC • cystic • associated with thyroglossal duct cyst or adjacent pyramidal lobe |
| 56 year old female with goiter (113 gm) and 1.4 cm nodule | Si787 | PTC with Warthin tumor-like and oncocytic features |
| 66 year old woman with thyroid nodules and dominant left 1.8 cm nodule | Si787 | Wide invasive Hurthle cell carcinoma with agioinvasion and neuroendocrine differentiation. + synapto • + CD56 • + PAX8 • - CEA • - chromo |
| 54 year old female with h/o HTN • ESRD on hemodialysis with R neck mass. CT/VIS shows R LAD and R thyroid nodule - bx cervical node | Si787 | c/w metastatic PTC. + TTF1 • PAX8 • HBME • thyroglobulin. BRAF equivocal |
| 28 year old male with h/o cardiac arrest s/p total thyroidectomy for amiodarone-induced thyrotoxicosis | Si787 | c/w amiodarone-induced thyrotoxicosis |
| 55 year old female with right thyroid neoplasm | Si787 | Minimally invasive follicular thyroid carcinoma • oncocytic type 1.8 cm |
| 66 year old male with a right thyroid nodule | Si787 | Microfollicular adenoma • clear cell type (3.4 cm) with no evidence of malignancy |
| 28 year old female with thyroid nodule | Si787 | PTC • encapsulated clear cell variant |
| 61 year old male with hoarseness and dysphagia. Neck u/s showed 2.3 cm R thyroid nodule. FNA - follicular neoplasm | Si787 | Widely invasive follicular thyroid carcinoma (4.2 cm) with clear cell features and extensive lymphovascular invasion and extrathyroidal extension. Hip lesion also present |
| 64 year old female with thyroid mass and lytic lesion of the humerous. Thyroid is excised. | Si787 | PTC • clear cell variant with extensive solid and insular growth pattern worrisome for evolution toward poorly diff. |
| 37 year old female with hypothyroidism | Si787 | Chronic lymphocytic (Hashimoto) thyroiditis • fibrous variant. IgG4-rich. Not necessarily associated with systemic disease in the thyroid but should be excluded |
| 65 year old male with lesions involving tonsils (B) • hyphopharynx (B) • base of tongue • nasopharyx • thyroid (B) • and lung • multifocal | Si787 | Papillary carcinoma • TTF1 + • lung vs thyroid |
| 74 year old man with 341 gm thyroid and a 4.5 cm mass | Si787 | Follicular thyroid carcinoma • oncocytic (Hurthle cell) type with multifocal angiovinvasion and additional high grade features |
| 46 year old female with 144 g goiter and dominent 3.5 cm mass | Si787 | Multinodular hyperplasdia with a 3.5 cm atypical follicular nodule |
| 54 year old female with an enlarging left thyroid nodule with FNA two months prior showing a follicular neoplasm • Hurthle cell type | Si787 | Follicular adenoma • oncocytic (Hurthle cell) type (2.5 cm). |
| 80 year old female with an aggressive thyroid lesion infiltrating the neck requiring carotid stent | Si787 | PTC • columnar cell variant with oncocytic features |
| 70 year old male with thyroid cancer | Si787 | Undifferentiated (anaplastic) thyroid carcinoma (atleast 10.5 cm) |
| 31 year old female with Graves disease for definitive tx. | Si787 | Papillary thyroid microcarcinoma (0.5 cm) with oncocytic and infiltrative features. Florid nodular papillary hyperplasia c/w Graves disease |
| 56 year old female with left paramidline neck mass | Si787 | c/w thyroglossal duct cyst with evidence of infection and cyst rupture |
| 50 year old male with lump in left side of neck 4 months prior with FNA. PTC | Si787 | PTC • tall cell variant (8 cm) met to LN with extrathyroidal extension. 2 months later - neck dissection showed undifferentiated carcinoma (S12-41329) and the patient died 6 months later |
| 34 year old male who noticed mass I his neck slowly growing over 4 years | Si787 | Undifferentiated (anaplastic) thyroid carcinoma (10.5 cm) arising in association with poorly differentiated carcinoma (RVL - 10/2007) |
| 64 year old male presents with stridor and tracheal stenosis discovered to have a thyroid mass | Si787 | PTC • classical variant with extrathyroidal extension • lymph node mets and parathyroid invasion |
| 57 year old man with Hashimoto disease. R/O alternative process | Si787 | Fibrosing variant of Hashimoto thyroiditis with 23 IgG4 cells/hpf • IgG4/IgG less than 10% not diagnostic of chronic sclerosing thyroiditis |
| 66 year old male with left thyroid mass | Si787 | Widely invasive follicular thyroid carcinoma • oncocytic (Hurthle cell) type • 12.5 cm. + LVI (ext) • + extrathyroidal extension • high grade features (necrosis) |
| 24 year old female with left sided thyroid nodule noted on clinical exam | Si787 | PTC • solid variant (3.0 cm) with increased mits • ? Necrosis • no invasion |
| 37 year old female with 1.3 cm L thyroid mass | Si787 | PTC • Warthin tumor-like variant |
| 86 year old male with a 4 cm L thyroid mass | Si787 | Widely invasive Hurthle cell carcinoma |
| 42 year old male with thyroid cancer | Si787 | PTC • classical type • multifocal with one nodule with features of hobnail variant • the other tall cell. BRAFVE + |
| 42 year old male with thyroid cancer | Si787 | PTC • classical type • multifocal with one nodule with features of hobnail variant • the other tall cell. BRAFVE + |
| 65 year old female with left-sided thyroid nodule | Si787 | Medullary thyroid carcinma (1.7 cm) |
| 33 year old female with two thyroid lesions • one with BRAF p.V600E (B6) • one with CCDC6::RET fusion product (B2) | Si787 | Classic papillary thyroid carcinoma • two foci • one with BRAF p. V600E and one with CCDC6::RET fusion |
| 56 year old with hemorrhagic 6 cm thyroid nodule | Si787 | Epithelioid angiosarcoma |
| 70 year old female with history of PTC | Si787 | Undifferentiated (anaplastic) thyroid carcinoma (3.2 cm) with extensive squamous differentiation |
| 31 year old female with non-toxic thyroid | Si787 | Dyshormonogenetic goiter (24 g) |
| 38 year old female with parathyroid enlargement | Si787 | Parathyroid carcinoma (1.2 cm) tumor infiltrates thyroid and SSF vascular invasion |
| 52 year old male presents with kidney stones and elevated PTH | Si787 | Atypical parathyroid adenoma (2.0 cm) |
| 55 year old female with ↑ PTH (90-100)-nl 10-60' • normal renal function • osteoporosis • 2 ↑ parathyroids on u/s and one gland with gestamibi uptake | Si787 | Medullary adenoma (0.6 gm • 1.2 cm). One (1) normocellular gland 60 mg |
| 69 year old female with left inferior paratracheal mass and history of adrenal disease on spironolactone with elevated PTH and clcium | Si787 | Enlarged (3.4 g) hyperplastic parathyroid with rare peripheral stromal fat. Possible water clear cell adenoma |
| 42 year old female with Alport syndrome (mut coll IV) s/p 2 failed kidney transplants with ESRD | Si787 | Multigland parathyroid hyperplasia c/w secondary hyperparathyroidism |
| 44 year old male s/p kidney transplant for IgA nephropathy pending 2nd tx with morbid obesity (5'10" • 300 lb) | Si787 | Nodular hyperplasia X 4 glands ? Tertiary hyperparathyroidism |
| 38 year old female with hyperparathyroidism | Si787 | Atypical parathyroid adenoma (2.2 gm) |
| 30 year old woman with hyperparathyroidism | Si787 | Parathyroid adenoma |
| 66 year old male with 21 gram R mediastinal mass (4.7 cm) | Si787 | Parathyroid lipoadenoma (4.7 cm) negative for malignancy |
| 71 year old female with hyperparathyroidism | Si787 | Atypical parathyroid adenoma (1.8 cm) at least partly intrathyroidal |
| 44 year old male with enlarged R parathyroid with 117 PTH | Si787 | Atypical parathyroid adenoma (5.2 g) parafibromin retained. No overt features of malignancy |
| 55 year old female with primary hyperparathyroidism | Si787 | Parathyroid adenoma with nodular fasciitis-like change |
| 59 year old male with (B) Thyroid nodules | Aja51 | Papillary thyroid microcarcinoma one BRAF + classical 2 BRAF - FV |
| 31 year old woman with a right-sided 2.3 cm adrenal mass. | Pms36 | Aldosteronoma (2.3 cm) • positive for CYP11B2 with additional aldosterone producing centers. Reticular stain shows a retained reticulin network without disruption. |
| 49 year old female with an incidental ~4 cm left adrenal mass noted on CT for r/o PE. | Emw8 | Pheochromocytoma (4.2 cm) with prominent stromal hyalinization. |
| 50 year old male with adrenal excision in 2008 (A) and follow up "suprarenal" mass excision in 2010 (B). | Emw8 | Adrenal cortical neoplasm (A).
Consistent with metastatic adrenal cortical carcinoma (B). Tumor cells are positive for inhibin Melan A • and synaptophysin and negative for chromogranin • renal cell carcinoma antigen • carbonic anhydrase and PAX8. |
| 54 year old female with Cushing syndrome for several months and 11 cm left adrenal mass. | Emw8 | Adrenal cortical carcinoma (13.5 cm)
+ LVI Mits 11:20 hpf |
| 71 year old female with Cushing syndrome and 13.0 cm left adrenal mass. | Emw8 | Myxoid adrenal cortical carcinoma (13.0 cm) with largely tubular growth.
+ LVI 8:50 hpf Focal tumor necrosis. |
| 52 year old with right adrenal mass. | Emw8 | Adrenal cortical adenoma (4.2 cm) adjacent adrenal with nodular cortical changes • regenerative changes versus nodular hyperplasia. Clinical correlation is needed. |
| 44 year old female with right adrenal mass. | Emw8 | Adrenal cortical adenoma (4.0 cm). |
| 54 year old male with HTN and hypokalemia with elevated serum aldosterone (30) and aldo/renin = 6.5/0.6 | Emw8 | 38 g adrenal cortical adenoma (0.8 cm). |
| 76 year old male who presents with 2-3 episodes of syncope associated sweating • elevated catecholamines and a 2.5 cm right adrenal mass. | Emw8 | Pheochromocytoma (3.6 cm) |
| 52 year old female with relevant medical history; now with right adrenal mass. | Emw8 | Metastatic melanoma • 2.1 cm. |
| 42 year old male with left adrenal mass • cystic lesion. | Emw8 | Mesothelial inclusion cyst (3.2 cm). There is no evidence of neoplasia. |
| 66 year old male with right adrenal mass • rib lesion and elevated PSA. | Emw8 | Malignant pheochromocytoma (12.0 cm) met to rib. Grade 6 prostate cancer • minimal. |
| 17 year old male with para-aortic tumor. | Emw8 | Paraganglioma (2.5 cm) with loss of SDHB suggestive of SDHB mutation. |
| 27 year old female with h/o adrenal pheochromocytoma in 1999 • lung paraganglioma in 2003 and right ear paraganglioma in 2005. Now presents with carotid body tumor. | Emw8 | Paraganglioma (carotid body tumor) 2.8 cm • in aggregate; LVI is noted. |
| 27 year old female with right adrenal mass. | Emw8 | Atypical pheochromocytoma (7.0 cm)
Increased vascular invasion Increased atypical mitoses + SDHB stain (intact). |
| 28 year old male with 1 year history of 14 cm left adrenal tumor s/p excision. | Emw8 | Metastatic pheochromocytoma to lung tumor shows retained SDHB. |
| 23 year old female with 19 g left adrenal and 2.5 cm mass. | Emw8 | Oncocytic adrenal cortical adenoma with myelolipomatous changes • periadrenal. |
| 58 year old female with (B) adrenal masses. (R) adrenalectomy. | Emw8 | Adrenal cortical adenoma (4.0 cm). B-catinin intact. Ki67 <1% |
| 53 year old female with left adrenal mass and relevant clinical history. | Emw8 | Metastatic melanoma (4 cm). |
| 51 year old male with incidental 5.0 cm left adrenal nodule with no symptoms. | Emw8 | Atypical adrenal cortical neoplasm (5.2 cm) with marked endocrine nuclear atypia. No overt features of malignancy. |
| 70 year old male with end stage kidney disease and hypertension with aldosterone/renin levels suggestive of aldosteronoma. | Emw8 | Adrenal cortical adenoma (1.2 cm) c/w aldosteronoma with spironolactone bodies secondary to prior treatment. |
| 43 year old male with malaise • nausea and diarrhea with a 5 cm lobulated left adrenal mass. | Emw8 | Ganglioneuroma likely producing VIP. |
| 36 year old female with right lower quadrant pain underwent CT for r/o appendicitis has a 4.9 cm left retroperitoneal lesion abutting but not necessarily emanating from the adrenal gland. | Emw8 | 11.1 gm ganglioneuroma (6.5 cm) • extraadrenal. |
| 41 year old female with history of pituitary tumor and now with right-sided adrenal mass compatible with pheochromocytoma also elevated PTH . Father with renal cell carcinoma. | Emw8 | Atypical pheochromocytoma (3.7 cm). Dark nests of cells suspicious for vascular invasion. SDHB - |
| 50 year old female presented with supraclavicular fullness and plethora found to have Cushing syndrome. Left adrenal mass. | Emw8 | Adrenal cortical adenoma • 2.9 cm. |
| 42 year old male with Cushing syndrome and bilateral adrenal nodular hyperplasia. | Emw8 | Nodular adrenal cortical hyperplasia.
R - 132 g L - 142 g |
| 47 year old male with recurrent left renal cell carcinoma and a left adrenal mass. | Emw8 | Metastatic renal cell carcinoma • clear cell type • to the adrenal. |
| 48 year old female with left adrenal nodule • 3.1 cm • noted on CT 4 years prior for unrelated reason. Recently presents to ED with abdominal pain. CT reveals adrenal mass is now 4.7 cm. Endocrine markers are negative. | Emw8 | Adrenal cortical adenoma (5.0 cm). B-catenin with mixed nuclear and cytoplasmic staining. Mutational analysis required if + for mutation • 20% benign • 80% malignant. Close clinical follow-up. CTNNB p. S45P. |
| 53 year old female with left adrenal mass. | Emw8 | Adrenal cortical adenoma (9.5 cm).
Ki67 1-2% + nuclear B-catenin |
| 41 year old Asian male with 3 year history of HTN treated with lisinopril. RUQ pain 3 months prior to surgery. B. Adrenal masses. | Emw8 | Macronodular adrenal cortical hyperplasia with a 3.8 cm left dominant nodule. |
| 52 year old male with left adrenal tumor. | Emw8 | Malignant composite pheochromocytoma. 25% pheo and 75% ganglioneuroblastoma. |
| 43 year old male with left adrenal mass. | Emw8 | Adrenal cortical carcinoma. |
| 41 year old with left adrenal mass. | Emw8 | Adrenal cortical carcinoma (7.9 cm). 230g excision.
mits 14:10 hpf + LVI + B-catenin mutation |
| 63 year old female with 24 cm left adrenal mass. | Emw8 | Adrenal cortical carcinoma (24 cm).
+ LVI 5:50 hpf Ki67 1-2% |
| 53 year old male with right renal mass and adrenal mass. | Emw8 | Adrenal gland: nodular hyperplasia.
Kidney: RCC • clear cell type. VHL dx @ 16 yr |
| 61 year old male s/p left flank blunt trauma with adrenal hematoma 10 months prior. | Emw8 | 171g adrenal cortical carcinoma (7.5 gm) |
| 55 year old male with left adrenal mass. | Emw8 | Pheochromocytoma (38.7 g) 1.9 cm decreased SDHB |
| 74 year old female with left adrenal mass. | Emw8 | Adrenal cortical adenoma (3.2 cm) with central hemorrhage and organizing thrombus. Multiple myelipomatous change. |
| 66 year old female with Cushing Syndrome. | Emw8 | Left and right diffuse nodular adrenal cortical hyperplasia c/w ACTH-dependent disease. |
| 56 year old female with right adrenal lesion(s). | Emw8 | Pheochromocytoma (5.5 cm) extra-adrenal paraganglioma (2.3 cm) neurofibromas up to 0.5 cm. |
| 48 year old female with a left adrenal mass (37g adrenalectomy). | Emw8 | Pheochromocytoma • two foci (3.0 and 2.5 cm) SDH retained. Focal bizarre endocrine atypia. Close follow-up recommended. |
| 69 year old male with adrenal gland resection. | Emw8 | Adrenal cortical adenoma. |
| 55 year old female with right adrenal mass. | Emw8 | Composite pheochromocytoma - ganglioneuroma (2.5 cm) completely excised. SDHB retained. |
| 59 year old male with left adrenal lesion. | Emw8 | Nodular adrenal cortical hyperplasia with a dominant (2.8 cm) nodule. |
| 27 year old male who presents with marked hypertension and a pre-op visit for wisdom tooth extraction (220/120) and >10 cm left adrenal mass. | Emw8 | Malignant pheochromocytoma • 800 gm • 14 cm with invasion of adrenal vein with large tumor thrombus. |
| 33 year old female with h/o MEN1 syndrome with concurrent well-differentiated pancreatic neuroendocrine tumor • grade 1 • with ductules of the pancreatic tail; also with 43g left adrenalectomy for 4.2 cm mass. | Emw8 | Atypical myxoid adrenal cortical neoplasm with adjacent nodule adrenal cortical change. Medulla unremarkable. Mits 7:50 hpf. Ki67 11.4%.
1. >5% 150 hpf. 2. high Fuhrman grade. 3. <25% clear cells. → low grade myxoid adrenal cortical carcinoma |
| 79 year old female with retroperitoneal mass. mits 3/10 hpf | Emw8 | Paraganglioma • worrisome for malignancy. |
| 50 year old male with nodular bilateral adrenal enlargement. | Emw8 | Marked adrenal cortical nodular hyperplasia with an expanded medulla. |
| 44 year old obese man with congenital adrenal hyperplasia with massive left sided adrenal compressing the spleen and stomach. | Emw8 | Myelolipoma (20.5 cm) arising in association with multinodular eosinophilic adrenal cortical hyperplasia. |
| 75 year old female with multiple hemangiomas and large adrenal mass. | Emw8 | Angiosarcoma • grade 2/3 arising within an adrenal cortical adenoma (11 cm) with lipomatous metaplasia. |
| 51 year old woman with growing cystic left adrenal lesion (22 gm). | Emw8 | Cystic follicular thyroid lesion (3.3 cm) (benign). |
| 71 year old female with left adrenal mass. | Emw8 | Adrenal cortical nodular hyperplasia with a dominant 3.0 cm adenomatous nodule. |
| 12 year old male with 5 cm adrenal mass. | Emw8 | Ganglioneuroma (4.7 cm) adjacent to uninvolved adrenal gland. |
| 53 year old male with left adrenal mass and concurrent lung lesion. | Emw8 | Metastatic poorly differentiated carcinoma c/w lung primary. |
| 48 year old female with episodic pain X 12 years of RLQ and multiple paraaortic • paracaval and intrahepatic nodules. Here • retroperitoneal tumor. | Emw8 | Malignant paraganglioma • multifocal. |
| 1 year old female with 15 watery stools qd. | Emw8 | Ganglioneuroma secreting VIP. |
| 54 year old woman with history of papillary thyroid cancer • hyperparathyroidism and Cushing syndrome with a 2.5 cm left adrenal mass. | Emw8 | Adrenal cortical adenoma (3.0 cm). Eosinophilic • lipofuscin pigment • lipomatous metaplasia c/w cortisol-producing adenoma. |
| 49 year old female with CT abdomen/pelvis and cystoscopy for microscopic hematuria with incidental adrenal mass (3.4 cm) with normal adrenal hormone levels. | Emw8 | Adrenal cortical oncocytoma (4.0 cm) |
| 47 year old female with 7 year history of "burning in chest and throughout body". | Emw8 | Pheochromocytoma (3.9 cm) with normal adjacent adrenal. |
| 25 year old female with HTN X 5 years and right adrenal mass. | Emw8 | Adrenal cortical adenoma (2.7 cm) |
| 55 year old male with abdominal pain and CT scan revealed a "huge" LUQ mass. | Emw8 | Adrenal pseudocyst (16.0 cm). No overt features of malignancy. |
| 48 year old female with tuberous sclerosis and bilateral angiomyolipomatous kidneys • now with large right superior pole kidney mass. | Emw8 | Adrenal cortical carcinoma • 6.1 cm. |
| 48 year old female transferred with MI • worsening episodic headache • tachycardia and palpitations. MR → 6 cm left adrenal mass. | Emw8 | Pheochromocytoma (6.0 cm). |
| 41 year old male with acute left flank pain. CT shows left adrenal mass. | Emw8 | Myelolipoma (9.5 cm). |
| 56 year old woman with leg swelling and weight gain. | Emw8 | Macronodular hyperplasia with marked adrenal enlargement (110 gm) with 5.5 cm dominant nodule • extension into periadrenal adipose tissue • myelolipomatous and lipomatous metaplasia • always bilateral • often delay (in years) of bilateral presentation. ACTH-independent. |
| 56 year old male with MENZA • bilateral adrenal lesions and a liver lesion. | Emw8 | Bilateral pheo (0.5 cm) with cortical and medullary hyperplasia. Metastatic medullary thyroid carcinoma to liver (prior thyroidectomy) |
| 25 year old female with HTN x 5 years and a 2.7 cm right adrenal mass found on imaging. | Emw8 | Adrenal cortical adenoma (2.7 cm). |
| 41 year old female • pregnant • with severe HTN • headaches and pre-eclampsia → MR 4 cm left adrenal mass. | Emw8 | Pheochromocytoma (4.2 cm) |
| 65 year old female with hypothyroidism with neck tenderness December 2009 • hard right-side neck nodule with FNA+ PTC. | Emw8 | Undifferentiated (anaplastic) thyroid carcinoma arising in association with papillary thyroid carcinoma • hobnail variant (4.5 cm). |