Definition/General

Introduction:
-Adrenocortical adenoma is a benign neoplasm arising from the adrenal cortex
-It represents the most common benign adrenal tumor
-It may be functional or non-functional
-FNAC shows characteristic cortical cell morphology without malignant features.
Origin:
-Arises from cortical cells of the adrenal gland
-May originate from any cortical zone (zona glomerulosa, fasciculata, reticularis)
-Functional adenomas produce excess hormones
-Non-functional adenomas are hormonally inactive
-Usually well-encapsulated.
Classification:
-Classified as functional or non-functional
-Aldosterone-producing adenoma (Conn syndrome)
-Cortisol-producing adenoma (Cushing syndrome)
-Androgen-producing adenoma (virilization)
-Non-functional adenoma (incidentaloma)
-Size <4 cm typically benign.
Epidemiology:
-Peak incidence in 4th-6th decades
-Female predominance (2:1 ratio)
-Unilateral presentation typical
-Bilateral adenomas rare
-Associated with multiple endocrine neoplasia syndromes rarely
-Indian population shows similar demographics.

Clinical Features

Presentation:
-Asymptomatic (non-functional adenomas, incidentalomas)
-Hormonal excess symptoms (functional adenomas)
-Hypertension (aldosterone-producing)
-Cushingoid features (cortisol-producing)
-Virilization (androgen-producing)
-Mass effect rare.

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Gross Description

Appearance:
-Well-encapsulated, round to oval mass
-Golden-yellow cut surface (lipid-rich)
-Homogeneous appearance
-Size typically 2-5 cm
-Soft consistency
-No necrosis or hemorrhage.
Characteristics:
-Bright golden-yellow due to abundant lipid
-Well-demarcated from normal adrenal
-Thin fibrous capsule
-Uniform cut surface
-No calcifications typically
-Compression of adjacent cortex.

Microscopic Description

Immunohistochemistry

Positive Markers:
-Inhibin alpha (strongly positive)
-SF-1 (steroidogenic factor 1)
-Melan-A (MART-1) (positive)
-Synaptophysin (positive)
-Chromogranin (variable)
-Calretinin (positive)
-Vimentin (positive).
Negative Markers:
-Cytokeratins (negative)
-EMA (negative)
-CEA (negative)
-TTF-1 (negative)
-PAX8 (negative)
-Hepatocyte marker (negative)
-RCC marker (negative).
Diagnostic Utility:
-Inhibin and SF-1 positivity confirms adrenocortical origin
-Melan-A positivity supports adrenal cortical differentiation
-Combination of markers distinguishes from other tumors
-Negative epithelial markers exclude carcinomas.

Molecular/Genetic

Differential Diagnosis

Sample Pathology Report

Template Format

Sample Pathology Report

Complete Report: This is an example of how the final pathology report should be structured for this condition.

Clinical Correlation

Patient with [adrenal mass] measuring [size] cm. [Functional/Non-functional] based on biochemistry

Specimen Information

FNAC from [adrenal mass], [side], performed under [guidance method]

Specimen Adequacy

[Adequate/Inadequate] for cytological interpretation

Cytological Findings

Cellular smears showing [uniform cortical cells] in [cohesive clusters]. Cells show [abundant eosinophilic cytoplasm] and [uniform nuclei]

Key Morphological Features

[Uniform cell population/Abundant cytoplasm/Uniform nuclei/Rare mitoses/No pleomorphism] observed

Background

Background shows [normal adrenal cortical cells/clean background]

Cytological Diagnosis

[Benign] - Features consistent with adrenocortical adenoma

Size Correlation

Cytological features consistent with [benign behavior] in lesion measuring [size] cm

Recommendations

[Histopathological correlation/Clinical and biochemical correlation/Surgical management] as clinically indicated

Note

FNAC findings support benign adrenocortical neoplasm. Clinical correlation for functional status recommended