Adrenal cortical tumor

Primary hyperaldosteronism. Used as an aid in preparing patients with adrenal cortical tumors for surgery. 

Carcinomas that are almost invariably negative but may occasionally show rare CK7-positive cells include hepatocellular carcinomas, duodenal ampullary carcinomas, colon carcinomas, renal (clear cell type), prostate, and adrenal cortical tumors. 

Renshaw AA, Granter SR. A comparison of A103 and inhibin reactivity in adrenal cortical tumors distinction from hepatocellular carcinoma and renal mmors. Mod Pathol. 1998 11 1160-1164. 

Loy TS, Phillips RW, Linder CL. A103 immunostaining in the diagnosis of adrenal cortical tumors an immunohistochemical study of 316 cases. Arch Pathol Lab Med. 2002 126 170-172. 

The main difficulties lie in the differentiation of adrenal cortical tumors from adrenal medullary tumors, namely, pheochromocytomas, and the differentiation of adrenal tumors from extra-adrenal tumors (i.e., metastatic carcinomas or primary carcinomas of neighboring structures such as the kidney or liver) (Fig. 10.30). 

Similar patterns of gene expression occur in pediatric adrenal cortical tumors with a consistent marked decrease in the expression of all histocompatibility class II genes in carcinomas as compared with adenomas. These results parallel the observations by Marx and colleagues that prenatal and postnatal adrenals do not express MHC class II antigens in contrast to adult adrenals, which express these antigens. 

Browning L, Bailey D, Parker A. D2-40 is a sensitive and specific marker in differentiating primary adrenal cortical tumors from both metastatic clear cell renal cell carcinoma and pheochromo-cytoma. / Clin Pathol. 2008 61 293-296. 

Primary effusion lymphoma, thyroid carcinoma, breast carcinoma, adrenal cortical tumors, keratoacanthomaO... 

Gastrointestinal, pancreas, biliary, lung, transitional cell, sweat glands, mucosal squamous cell, mucinous carcinomas of female GU tract, medullary carcinoma of thyroid Breast, squamous cell, endometrioid, Brenner tumor Renal cell, hepatocellular, prostate, follicular thyroid, adrenal cortical, serous carcinomas of female GU tract, embryonal, yolk sac, mesothelioma... 

In animal studies aldrin induced an increased incidence of hepatocellular carcinoma at two dietary doses in male mice the tumors showed a significant dose-response trend and were statistically significant at the high dose. Follicular cell tumors of the thyroid and adrenal cortical cell adenomas were increased in female rats in the low-dose group but not in the high-dose group the results could not be clearly associated with treatment. ... 

Dexamethasone Testing of adrenal cortical hyperfunction cerebral edema associated with primary or metastatic brain tumor, craniotomy, or head injury. Tnamc/no/one Treatment of pulmonary emphysema where bronchospasm or bronchial edema plays a significant role, and diffuse interstitial pulmonary fibrosis (Hamman-Rich syndrome) in conjunction with diuretic agents to induce a diuresis in refractory CHF and in cirrhosis of the liver with refractory ascites and for postoperative dental inflammatory reactions. 

Stromal tumors but was recently found to be expressed in 73% of adrenal cortical tumors7 These findings were confirmed by Zhang and colleagues,who found all 16 of 16 (100%) and 11 of 12 (92%) adrenal cortical adenomas and carcinomas, respectively, were calretinin positive while none of 20 pheochromocytomas showed staining. 

Zhang PJ, Gen a EM, Tomaszewski JE, et al. The role of cal-retinin, inhibin, melan-A, bcl-2, and c-kit in differentiating adrenal cortical and medullary tumors an immunohistochemical study. Mod Pathol. 2003 16 591-597. 

Cote RJ, Cardon-Cardo C, Reuter VE, Rosen PP. Immuno-pathology of adrenal and renal cortical tumors Coordinated change in antigen expression is associated with neoplastic conversion in the adrenal cortex. Am J Pathol. 1990 136 1077-1084. 

Detection of hCG-producing tumors Adrenal cortical imaging Diagnosis of pheochromocytoma... 

However, severe, unrelenting neonatal acne accompanied by other signs of hyperandrogenism should prompt an investigation for adrenal cortical hyperplasia, virilizing tumors, or underlying endocrinopathies. 

Adrenal cortical carcinomas are rare, highly malignant tumors which account for only 0.2% of deaths due to cancer in the United States. Their incidence has been estimated a two per milhon per year. About half of these tumors produce hormonal and metabolic syndromes that lead to their discovery. The other half are silent and are defined with the appearance of metastasis or when the primary tumor becomes large enough to produce abdominal symptoms. While adrenal cancer can occur at any age, most cases are discovered between the ages of 30-50 years (Brennan 1987 Schteingart 2000). 

Embolization Adrenal arterial emboKzation was performed in nine of our patients, four with inoperable adrenal cortical carcinoma and five with metastatic adrenal tumors. In eight patients, palliative embolization was performed either to decrease tumor bulk, suppress tumor hormonal function (n=3), or relieve pain (n=4). In four patients in whom it was possible to assess the effect of embolization, a striking reduction in size had occurred in one (Fig. 9.13), the lesion remained stable in size for 12 months in two, and the tumor continued to grow in the fourth. A reduction in the production of cortisol for 12 months was seen in two of the three patients with Cushing s syndrome (Fig. 9.13). Adrenal emboKzation resulted in the effective palliation of pain in three out of four patients and may have contributed to its amehoration in the fourth. Apart from a hypertensive episode in one patient, no serious compKcations occurred (O Keeffe et al. 1988). 

Shull et al. (1956b) draw the conclusion that the striking increase in G-6-Pase activity per gm. of liver observed in tumor-bearing mice indicates that the activity of this enzyme in vivo is probably controlled, at least in part, by the adrenal cortical hormones. The authors also noted that these tumor-bearing mice excrete 0.5 mS- per day total neutral Cjx steroids in the urine of which corticosterone comprised 0.3 ng. (Schull et al, 1956b). Only traces of Compounds E and F and no aldosterone were found. Therefore, the 45 % increase in G-6-Pase activity observed in the tumor-bearing mice was probably produced largely by corticosterone. 

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