Adrenal biopsy

Because of early dissemination, staging of patients with small-cell lung cancer is more extensive than for patients with NSCLC. It is important to rule out distant metastasis because it will change the role of thoracic radiation in the treatment of these patients. Staging should include a complete history and physical examination, CAT scans of chest and upper abdomen to include the liver and adrenal glands, brain MRI scan, bone scan, complete blood count, and a possible bone marrow aspiration and biopsy. 

Nofetumomab is a mouse monoclonal antibody coupled to 99mTc that is used for diagnostic purposes to determine extent of disease and to stage patients with small cell lung cancer. It binds a 40-kD antigen found on many tumor cell types, but also on some normal cells. It is an accurate indicator of extent of disease in biopsy-confirmed small cell lung cancer except in those patients with brain or adrenal metastases. 

Shin SJ, Hoda RS, Ying L, DeLellis RA. Diagnostic utility of the monoclonal antibody A103 in fine-needle aspiration biopsies of the adrenal. Am J Clin Pathol. 2000 113 295-302. 

A 49-year-old woman was diagnosed with veno-occlusive disease, a form of Budd-Chiari syndrome. The patient had portal hypertension associated with obliteration of the smaller hepatic venules. A liver biopsy specimen showed centrilobular necrosis and congestion. The woman had been regularly taking two products that contained comfrey, one for 6 months and the other for 4 months. Analyses of products taken indicated an estimated intake of pyrrolizidine alkaloids of 0.49 to 1.45 ng/kg daily. Other supplements being taken by the woman included a number of vitamins, minerals, and sterotrophic adrenal bovine extract (Ridker et al. 1985). 

Fig. 7.13. A 1-year-old boy with a solid tumour arising from the adrenal gland. Biopsy was performed to confirm the diagnosis of neuroblastoma and to obtain specimen for genetic marker studies. The biopsy was done using freehand technique, the arrow delineates the hiopsy needle. S, spleen M, mass...

Adrenal Glands. Due to the anatomic localization in the upper retroperitoneum, the access path for biopsy is relatively sophisticated while several approaches are possible ... 

One investigator failed to observe any change in the blood, liver, kidney, pancreas, and muscle GSH level in the dog following adrenaline (0.3 mg./kg. intramuscularly) (140). A second investigator who compared the GSH content of muscle obtained at biopsy a number of days before and shortly after the injection of adrenaline reported a consistent increase in demedullated cats (25 %), whereas the change was less consistent in animals with intact adrenals (141). A third investigator has reported a consistent increase (62 %) in heart GSH level in rabbits 4 hr. after the subcutaneous injection of adrenaline (0.5 mg./kg.) (142). It is probable that the reported discrepancies in the literature are due to differences in species, dose of adrenaline, and time of observation. 

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