mgh:cyto-1-13

1-13 Adrenal: R Tambouret MD, E Brachtel MD, R Arpin CT

• Indications for cytology examination
• Procuring the specimen
• Test platforms/specimen processing and triage
• Report

Basic cytomorphology

Normal adrenal cells – N13-6084

• Variable Cellularity
• Cortex:
  • Bare nuclei with foamy lipid from stripped cytoplasm background
  • Single cells with round nuclei, inapparent nucleoli
  • In intact cells, abundant vacuolated cytoplasm with frayed edges
• Medulla
  • Rarely sampled, cells have basophilic cytoplasm
  • Large eccentric nucleus with fine chromatin
  • Conspicuous nucleoli

Adrenal cortical nodules (hyperplastic, adenomas)

• Usually indistinguishable from benign cortical cells

Pheochromocytoma – C91-C20757

• Loosely cohesive round/plasmacytoid to spindled cells
• Fibrillary cytoplasm, oval hyperchromatic nuclei - may show anisonucleosis/pleomorphism/binucleation
• Melanin pigment in some cells
• Red cytoplasmic granularity on air dried material
• Synaptophysin, chromogranin positive; S-100 positive in spindle cells
• MIMICS: Adrenal cortical carcinoma, other poorly differentiated malignancies

Adrenal cortical carcinoma – C99-T12804

• May not be able to diagnose on cytology alone, but may suspect if mitoses, necrosis or marked pleomorphism is present

Histological assessment required to distinguish larger adenomas from carcinomas

Metastases –N13-6638, C95-N3969 and C97-R25603

• cell population resembling primary tumor