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Hematoxylin & eosin

History: The patient was a 62 year-old man who presented to the hospital with a history of left flank pain of unknown duration and recent hematuria. An MRI studied demonstrated a 3.4 cm solid mass in his left kidney. A radical nephrectomy was performed and the mass was proved to be a clear cell renal cell carcinoma. The adrenal gland was also removed and a small 2 cm solid nodule was noted. The image being shown here was obtained from the adrenal nodule.

Gross Pathology: The tumor is 2.2 cm in greatest dimenstion. It is in the form of a single, well-demarcated nodule surrounded by a thin layer of normal appearing adrenal cortex. The tumor has a pale yellow, solid cut surface without any hemorrhage or necrosis. The residual adrenal cortex does not show any evidence of atrophy.

Histologic Highlights of this Case:

• The diagnostic features of adrenal gland can be seen in Area 1.

• The tumor (T) is well demarcated from the surrounding residual adrenal gland (A) and the interface can be seen in area 2.

• The tumor (Area 3) is composed of solid sheets of monotonous, polygonal cells with foamy cytoplasm, distinct cytoplasmic membrane, and centrally located nuclei. There is no significant pleomorphism or enlargement of nuclei. No prominent nucleoli are noted. When compared to the normal cells of the residual adrenal cortex (Area 1), there are distinct similarities between the normal and neoplastic cells.

Comment: Adrenocortical adenomas are often, but not always, incidental finding particularly when they are small and non-functional. These tumor can be functional or non-functional and morphologic features alone cannot determine whether they are functional. Clinical assessment and laboratory measurement of the hormone level is necessary. However, functional adrenocortical adenomas are often associated with atrophy in the associated adrenal cortex and in the contralateral adrenal gland.