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肺结核病时肾上腺的干酪样肉芽肿性炎。过去肺结核是慢性肾上腺功能不全最常见的原因,现在特发性(可能与自身免疫有关) Addison 病是慢性肾上腺功能不全的更常见原因。

This is a caseating granuloma of tuberculosis in the adrenal gland. Tuberculosis used to be the most common cause of chronic adrenal insufficiency. Now, idiopathic (presumably autoimmune) Addison's disease is much more often the cause for chronic adrenal insufficiency.

刚果红染色显示肾上腺皮质内淀粉样物质沉积。

Here are Congo red stained deposits of amyloid in the adrenal cortex. Amyloid may collect in adrenal as well as other organs.

新生儿患有先天性右肾上腺神经母细胞瘤。肿瘤(白色箭头所示)把肝脏推向左侧。

This neonate had a congenital neuroblastoma of the right adrenal. This neoplasm (marked by the white arrow) is displacing the liver to the left of the body.

神经母细胞瘤的显微镜外观,属于小细胞(肿瘤细胞小而圆)肿瘤。被查出之前,往往在腹膜后腔能长得很大。通常会出现坏死和钙化。

This is a microscopic appearance of neuroblastoma, which is one of the "small round blue cell" tumors. These neoplasms can reach a large size in the retroperitoneum before detection. They often contain areas of necrosis and calcification.

库欣综合征的肾上腺皮质腺瘤病人的肾上腺被手术切除,肾上腺切为两半可见腺瘤。右边是残余萎缩的肾上腺。腺瘤由类似肾上腺皮质一样黄*色坚韧组织构成,边界清楚。组织学上,肿瘤细胞分化较好,由类似于皮质束状带细胞构成,属良性肿瘤。

This adrenal gland removed surgically in a patient with Cushing's syndrome has been sectioned in half to reveal an adenoma. Some remaining atrophic adrenal is seen at the right. The adenoma is composed of yellow firm tissue just like adrenal cortex. This neoplasm is well-circumscribed. Histologically, it is composed of well-differentiated cells resembling cortical fasciculata zone. It is benign.

高血压病人左侧肾上腺的直径为1.3厘米的腺瘤。常规电解质检测显示低钾血症。进一步检测发现醛固酮升高和肾素降低,结果与醛固酮分泌性肾上腺腺瘤( Conn综合症)一致。这种病变占原发性醛固酮增多症(PHA)的2/3,而双侧肾上腺增生占PHA的30%。腺瘤的典型表现是直径小于2cm、切面呈黄*色。

Here is a 1.3 cm left adrenal adenoma found in a patient with hypertension. She had hypokalemia on a routine chemistry panel. Further workup revealed a high serum aldosterone and a low serum renin, findings consistent with an aldosterone secreting adrenal adenoma (Conn's syndrome). This lesion accounts for about two-thirds of cases of primary hyperaldosteronism (PHA), while bilateral adrenal hyperplasia accounts for about 30% of PHA. Such adenomas are typically less than 2 cm in size and yellow on cut surface.

显微镜下,右侧的肾上腺皮质腺瘤类似正常的肾上腺束状带,左边为包膜。肿瘤细胞具有一定的异型性。

Microscopically, the adrenal cortical adenoma at the right resembles normal adrenal fasciculata. The capsule is at the left. There may be some cellular pleomorphism.

很大的肾上腺皮质癌,把左肾推向下方,通常是功能性肿瘤(分泌肾上腺皮质激素或性激素),预后较差。

This is a large adrenal cortical carcinoma which is displacing the left kidney downward. Such neoplasms are usually functional (secreting corticosteroids or sex steroids). They have a poor prognosis.

右侧是残余肾上腺,左边是肾上腺皮质癌。

There is residual adrenal at the right, and an adrenal cortical carcinoma is at the left.

肾上腺皮质癌高倍镜图像显示,肿瘤和正常的肾上腺皮质非常相似。仅从内分泌肿瘤的细胞学检查很难确定为恶性。因此,浸润(如此处浸润静脉)和转移才是最可靠的指标。幸运的是,绝大部分内分泌肿瘤都是良性腺瘤。

This high power microscopic appearance of an adrenal cortical carcinoma demonstrates that the neoplasm closely resembles normal adrenal cortex. It is difficult to determine malignancy in endocrine neoplasms based upon cytology alone. Thus, invasion (as seen here in a vein) and metastases are the most reliable indicators. Luckily, most endocrine neoplasms are benign adenomas.


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