Adrenal & paraganglia

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Figure 29.1 Pathways of corticosteroidogenesis

Figure 29.2 The three layers of the normal adrenal cortex: A, glomerulosa; B, fasciculata; C, reticularis

 Figure 29.3 Normal paraganglion found incidentally in the retroperitoneal region. A, Hematoxylin-eosin; B, chromogranin

Figure 29.4 Fine-needle aspiration specimen from an adrenal cortical adenoma

 Figure 29.5 Adrenal renal fusion showing adrenal cortical tissue admixed with renal tubules (on right)

 Figure 29.6 Primary pigmented nodular adrenal cortical hyperplasia. A, A micronodular pattern of growth is characteristic. B, Nodules are comprised of eosinophilic cells containing brown pigment

 Figure 29.7 Adrenal cortical hyperplasia showing multinodular pattern of growth

 Figure 29.8 Gross appearance of adrenal cortical adenoma with single nodule, well-circumscribed growth, and typical golden yellow color

 Figure 29.9 A-C, Various morphologic patterns within the same aldosterone-secreting adrenal cortical adenoma

 Figure 29.10 Adrenal oncocytoma. A, Hematoxylin-eosin; B, antimi- tochondrial immunostain; C, ultrastructural appearance. Numerous mitochondria with stacked tubulovesicular cristae, smooth endoplasmic reticulum, and two lysosomes are illustrated. (x31,200) (Courtesy of Dr. Robert E. Erlandson, Memorial Sloan-Kettering Cancer Center.)

 Figure 29.11 So-called spironolactone bodies. They appear as concentric laminated eosinophilic structures

 Figure 29.12 Immunohistochemical reactivity of adrenal cortical neoplasm.A, Inhibin; B, Melan A; and C, SF-1

Figure 29.13 A and B, Gross appearance of adrenal cortical carcinoma. Both tumors are large and exhibit areas of hemorrhage and necrosis. The tumor shown in A has destroyed the upper pole of the kidney

 Figure 29.14 Adrenal cortical carcinoma with more intratumoral heterogeneity

Figure 29.15 Adrenal cortical carcinoma. There is nuclear hyperchromasia, diffuse pattern of growth, and mitotic activity

 Figure 29.16 Myxoid adrenal cortical neoplasm with cord-like pattern of growth

 Figure 29.17 Gross appearance of adrenal neuroblastoma. A, The tumor exhibits a variegated appearance resulting from hemorrhage and necrosis. B, Suprarenal location strongly suggests the diagnosis of neuroblastoma in a child

Figure 29.18 Homer Wright rosettes in neuroblastoma. Note the absence of a central lumen

Figure 29.19 A, Undifferentiated neuroblastoma. There is no neuropil or cellular differentiation. Adjunctive diagnostic studies and clinical context are important in such cases. B, Poorly differentiated neuroblastoma is more lobular and associated with neuropil, the latter making diagnosis more straightforward

 Figure 29.20 Differentiating neuroblastoma contains greater than 5% of cells with varying levels of maturation, typically acquiring a more ganglion-like appearance

Figure 29.21 Ganglioneuroma of adrenal gland showing clusters of mature ganglion cells surrounded by fascicles of Schwann-like cells (i.e. Schwannian stroma). This diagnosis requires the absence of both neuropil and any nests of neuroblastic cells, which would warrant classification as ganglioneuroblastoma, intermixed

Figure 29.22 Ganglioneuroblastoma, nodular type, is characterized macroscopically by the tan ganglioneuromatous component that contains a dark nodule with stroma-poor neuroblastoma morphology. (Courtesy of Dr. Jason Jarzembowski, Medical College of Wisconsin.)

 Figure 29.23 Karyorrhectic bodies have eosinophilic cytoplasm and condensed, fragmented nuclear chromatin

 Figure 29.24 Gross appearance of adrenal pheochromocytoma. The tumor shown in A has a markedly variegated appearance. The lower half of the specimen shown in B was fixed in Zenker fluid and has acquired the typical dark brown color indicative of a positive chromaffin reaction