Neuroblastoma differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Neuroblastoma}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Neuroblastoma]]
{{CMG}} {{AE}}{{ZAS}}{{HL}}
{{CMG}} {{AE}}{{ZAS}}{{HL}}


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==Differentiationg Neuroblastoma from other Diseases==
==Differentiationg Neuroblastoma from other Diseases==
* Intra-abdominal neuroblastoma must be differentiated from other diseases that cause [[abdominal distention]] and [[constipation]] such as:<ref name="radio">Neuroblastoma. Radiopaedia(2015) http://radiopaedia.org/articles/neuroblastoma Accessed on October, 5 2015</ref>
'''Abbreviations'''
:* [[Wilms tumor]]
:* [[Rhabdomyosarcoma]]
:* [[Ganglioneuroma]]
:* Ganglioneuroblastoma
 
* Intra-thoracic neuroblastoma must be differentiated from other diseases that cause [[shortness of breath]] and chronic [[cough]] such as:
:* Intrathoracic [[lymphoma]]
:* Extra lobar [[pulmonary sequestration]]
:* Round [[pneumonia]]
:* [[Ganglioneuroma]]
:* Ganglioneuroblastoma


ACTH: Adrenocorticotropic hormone, ARR: Aldosterone-renin ratio, CAM: Cellular adhesion molecules, ERCP: Endoscopic retrograde cholangiopancreatography, ESR: Erythrocyte sedimentation rate, CT: Computerized tomography, Fluorescence in situ hybridization, FDG: Fluorodeoxyglucose, FSH: Follicle stimulating hormone, GI: Gastrointestinal, H&E stain: Hematoxylin and eosin stain, LCA: Leukocyte common antigen, LDH: Lactate dehydrogenase, LH: Luteinizing hormone, MEN: Multiple endocrine neoplasia, MRCP: Magnetic resonance cholangiopancreatography, MRI: Magnetic resonance imaging, N/A: Not applicable/Not available, N/L: Normal, PAS stain: Periodic acid–Schiff stain, PET: Position emission tomography, PGP: Protein gene product 9.5, TB: Tuberculosis, U/S: Ultrasound, ZF: Zona fasciculata, ZG: Zona granulosa, ZR: Zona reticularis.
{| class="wikitable"
{| class="wikitable"
! rowspan="2" |S.No.
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Adrenal Cortex
! rowspan="2" |Disease
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Product
! colspan="3" |Symptoms
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Clinical manifestations
! colspan="2" |Signs
! colspan="7" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
! colspan="3" |Diagnosis
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
! rowspan="2" |Comments
|-
|-
!Abdominal Pain
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
!Hematuria
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Signs
!Headache
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Blood & Urine
!Abdominal mass
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Histopathological
!Abdominal tenderness
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Others
!Ultrasonography
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Ultrasound
!CT scan
! style="background:#4479BA; color: #FFFFFF;" align="center" + |CT scan
!Histology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |FDG PET/CT
! style="background:#4479BA; color: #FFFFFF;" align="center" + |MRI
|-
|-
|1.
| rowspan="4" style="background: #DCDCDC; padding: 5px; text-align: center;" |Adrenal [[Adrenal adenoma|Adenoma]]
|[[Wilms' tumor|Wilms tumor]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aldosterone]]<br><ref name="pmid26867466">{{cite journal |vauthors=Park JJ, Park BK, Kim CK |title=Adrenal imaging for adenoma characterization: imaging features, diagnostic accuracies and differential diagnoses |journal=Br J Radiol |volume=89 |issue=1062 |pages=20151018 |date=June 2016 |pmid=26867466 |pmc=5258164 |doi=10.1259/bjr.20151018 |url=}}</ref><ref name="pmid25958045">{{cite journal |vauthors=Monticone S, Castellano I, Versace K, Lucatello B, Veglio F, Gomez-Sanchez CE, Williams TA, Mulatero P |title=Immunohistochemical, genetic and clinical characterization of sporadic aldosterone-producing adenomas |journal=Mol. Cell. Endocrinol. |volume=411 |issue= |pages=146–54 |date=August 2015 |pmid=25958045 |pmc=4474471 |doi=10.1016/j.mce.2015.04.022 |url=}}</ref><ref name="pmid20498828">{{cite journal |vauthors=Stowasser M, Taylor PJ, Pimenta E, Ahmed AH, Gordon RD |title=Laboratory investigation of primary aldosteronism |journal=Clin Biochem Rev |volume=31 |issue=2 |pages=39–56 |date=May 2010 |pmid=20498828 |pmc=2874431 |doi= |url=}}</ref><ref name="pmid24605256">{{cite journal |vauthors=Guerrisi A, Marin D, Baski M, Guerrisi P, Capozza F, Catalano C |title=Adrenal lesions: spectrum of imaging findings with emphasis on multi-detector computed tomography and magnetic resonance imaging |journal=J Clin Imaging Sci |volume=3 |issue= |pages=61 |date=2013 |pmid=24605256 |pmc=3935261 |doi=10.4103/2156-7514.124088 |url=}}</ref>
|<nowiki>+</nowiki>
|
|<nowiki>+ </nowiki>
* [[Headache]]
|<nowiki>-</nowiki>
* [[Vision]] problems
|<nowiki>+</nowiki>
* [[Muscle]] [[cramps]]
|<nowiki>+</nowiki>
* [[Muscle]] weakness & [[cramps]]
* [[Numbness]]
* Temporary [[paralysis]]
* [[Polyuria]] and [[polydipsia]]
|
* [[Hypertension]]
* [[Refractory hypertension]]
|
* [[Hypokalemia]]
* [[Alkalosis]]
* ↑ [[Plasma]] [[aldosterone]]
* ↓ [[Plasma]] [[Renin]]
* ↑ ARR
|
|
*It is the best initial diagnostic study used in cases suspected with [[Wilms tumor]].
* Single or multiple [[nodules]]
*[[Ultrasonography]] can help identify the mass as a kidney mass.
* Encapsulated
*It can distinguish [[tumor]] mass from other causes of renal swelling like [[hydronephrosis]].<ref name="pmid61529362">{{cite journal |vauthors=Hartman DS, Sanders RC |title=Wilms' tumor versus neuroblastoma: usefulness of ultrasound in differentiation |journal=J Ultrasound Med |volume=1 |issue=3 |pages=117–22 |date=April 1982 |pmid=6152936 |doi= |url=}}</ref>
* Abundant clear [[cytoplasm]]
*[[Doppler ultrasonography]] can help to detect invasion of [[renal vein]] and [[Inferior vena cava|IVC]] by the tumor.<ref name="pmid30036602">{{cite journal |vauthors=De Campo JF |title=Ultrasound of Wilms' tumor |journal=Pediatr Radiol |volume=16 |issue=1 |pages=21–4 |date=1986 |pmid=3003660 |doi= |url=}}</ref>
* Uniforming [[nuclei]]
* [[Histopathology]] may resemble:
** [[Zona fasciculata|ZF]] (large, [[lipid]]-laden clear [[cells]])
** [[Zona fasciculata|ZG]] (small, compact [[cells]] with moderate amount of [[lipid]])
** [[Zona reticularis|ZR]] (lipid-sparse [[cytoplasm]])
|
|
*Findings on [[CT scan]] which can be suggestive of  [[Wilms tumor]] include:<ref name="pmid4080660">{{cite journal |vauthors=Cahan LD |title=Failure of encephalo-duro-arterio-synangiosis procedure in moyamoya disease |journal=Pediatr Neurosci |volume=12 |issue=1 |pages=58–62 |date=1985 |pmid=4080660 |doi= |url=}}</ref>
* [[Fludrocortisone]] suppression testing (Gold standard)
**Heterogeneous soft-tissue density masses
* Oral [[Sodium]] loading
**These masses have frequent areas of [[calcification]] (~10%) and fat-density regions
* [[Saline]] infusion testing
**[[Lymph node]] metastasis
* [[Captopril]] test
*[[CT scan]] of the renal mass can further reveal:
* [[Adrenal venous sampling]]
**Invasion of surrounding organs
* Posture test
**[[Thrombus]] in or occlusion of the [[renal vein]] and/or the [[inferior vena cava]]
* [[Genetic testing]]
**Abdominal lymph nodes and contralateral involvement
* [[Immunohistochemical staining]]
*  
|
|
*Wilms tumor has a triphasic appearance.
* [[Adrenal]] [[mass]] or [[nodule]]
*It is comprised of 3 types of cells:
|
**[[Stromal]]
* [[nodule|Adrenal]] [[mass]] or nodule
**[[Epithelium|Epithelial]]
* [[nodule|Unilateral or bilateral]] [[adrenal]] [[atrophy]]
**[[Blastema|Blastemal]]
* [[nodule|Hypodense]] [[mass]]
*All the 3 types are not required for the diagnosis of Wilms tumor.
|
*Primitive tubules and [[Glomerulus|glomeruli]] are often seen comprised of [[Cancer|neoplastic]] cells.
* Iso and low [[FDG]] uptake compared with [[liver]]
*Beckwith and Palmer reported in NWTS the different histopathologic types of Wilms tumor to categorize them based on prognosis.<ref name="pmid1978">{{cite journal |vauthors=Jolly RD, Stellwagen E, Babul J, Vodkaĭlo LV, Titov VL, Moldomusaev DM, Maianskiĭ AN |title=Mannosidosis of Angus Cattle: a prototype control program for some genetic diseases |journal=Adv Vet Sci Comp Med |volume=19 |issue=23 |pages=1–21 |date=November 1975 |pmid=1978 |doi= |url=}}</ref>
|
* Hyperintense on in-phase and hypointense on oppose-phase
|
* [[Glucocorticoid]]-Remediable [[Aldosteronism]] responds to [[glucocorticoids]]
* Higher [[cardiovascular]] and [[cerebrovascular]] [[morbidity]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cortisol]]<br><ref name="pmid26867466">{{cite journal |vauthors=Park JJ, Park BK, Kim CK |title=Adrenal imaging for adenoma characterization: imaging features, diagnostic accuracies and differential diagnoses |journal=Br J Radiol |volume=89 |issue=1062 |pages=20151018 |date=June 2016 |pmid=26867466 |pmc=5258164 |doi=10.1259/bjr.20151018 |url=}}</ref><ref name="pmid18493137">{{cite journal |vauthors=Stratakis CA |title=Cushing syndrome caused by adrenocortical tumors and hyperplasias (corticotropin- independent Cushing syndrome) |journal=Endocr Dev |volume=13 |issue= |pages=117–32 |date=2008 |pmid=18493137 |pmc=3132884 |doi=10.1159/000134829 |url=}}</ref><ref name="pmid25871963">{{cite journal |vauthors=Zilbermint M, Stratakis CA |title=Protein kinase A defects and cortisol-producing adrenal tumors |journal=Curr Opin Endocrinol Diabetes Obes |volume=22 |issue=3 |pages=157–62 |date=June 2015 |pmid=25871963 |pmc=4560837 |doi=10.1097/MED.0000000000000149 |url=}}</ref><ref name="pmid29685132">{{cite journal |vauthors=Wei J, Li S, Liu Q, Zhu Y, Wu N, Tang Y, Li Q, Ren K, Zhang Q, Yu Y, An Z, Chen J, Li J |title=ACTH-independent Cushing's syndrome with bilateral cortisol-secreting adrenal adenomas: a case report and review of literatures |journal=BMC Endocr Disord |volume=18 |issue=1 |pages=22 |date=April 2018 |pmid=29685132 |pmc=5913873 |doi=10.1186/s12902-018-0250-6 |url=}}</ref>
|
* [[Weight]] gain
* [[Growth retardation]]
* [[Headache]]
* [[Amenorrhea]]
* [[Virilization]] (rare)
* [[Acne]]
* Violaceous [[striae]]
* [[Acanthosis nigricans]]
* [[Sleep]] disruption
* [[Mental]] changes
* [[Muscular]] weakneness
|
* [[Hypertension]]
* [[Hirsutism]]
* [[Hypogonadism]]
* [[Growth retardation]]
* [[Facial]] plethora
* [[Acne]]
* [[Striae]]
* [[Bruising]]
* [[Acanthosis nigricans]]
* [[Mental]] changes
* [[Muscular]] weakneness
|
* ↑ [[Plasma]] [[cortisol]]
* ↑ 24 Hour [[urinary]] [[cortisol]]
* ↓ or inappropriately normal [[plasma]] [[ACTH]]
* ↑ [[Blood]] [[glucose]]
|
* Yellow [[fat]]
* Brown [[discoloration]]
* Large [[cells]] with increased [[lipid]] contetnt (''[[zona fasciculata]])''
* May contain [[pigment]] ([[lipofuscin]])
* Adjacent [[Atrophy|atrophied]] [[cells]]
* [[Hemorrhage]] and [[calcification]] (Pre-[[malignant]] [[lesions]])
|
* Diurnal [[plasma]] [[cortisol]] variation
* Low dose and high dose [[dexamethasone suppression test]]
* [[Dexamethasone]]-[[CRH]] test
* Adrenal venous sampling
* [[Genetic testing]]
* [[Immunohistochemical staining]]
* [[Dual energy X-ray absorptiometry|Dual-energy X-ray absorptiometry]]
|
* [[Adrenal]] [[mass]] or [[nodule]]
* ↑ [[Fat]]
|
* [[Adrenal]] [[mass]] or [[nodule]]
* Unilateral or bilateral [[adrenal]] [[atrophy]]
* ↑ [[Fat]]
* Hypodense [[mass]]
|
* Iso and low [[FDG]] uptake compared with [[liver]]
|
* Hyperintense on in-phase and hypointense on oppose-phase
|
* Associated with [[Carney complex]]
* Associated with [[Multiple endocrine neoplasia type 1|MEN-1]]
* [[Plasma]] levels of [[cortisol]] and [[ACTH]] may show false positive and false negative results due to normal diurnal [[hormonal]] variation
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Androgens]]<br><ref name="pmid24605256">{{cite journal |vauthors=Guerrisi A, Marin D, Baski M, Guerrisi P, Capozza F, Catalano C |title=Adrenal lesions: spectrum of imaging findings with emphasis on multi-detector computed tomography and magnetic resonance imaging |journal=J Clin Imaging Sci |volume=3 |issue= |pages=61 |date=2013 |pmid=24605256 |pmc=3935261 |doi=10.4103/2156-7514.124088 |url=}}</ref><ref name="pmid16278716">{{cite journal |vauthors=Arnold DT, Reed JB, Burt K |title=Evaluation and management of the incidental adrenal mass |journal=Proc (Bayl Univ Med Cent) |volume=16 |issue=1 |pages=7–12 |date=January 2003 |pmid=16278716 |pmc=1200803 |doi= |url=}}</ref><ref name="pmid23819074">{{cite journal |vauthors=Rodríguez-Gutiérrez R, Bautista-Medina MA, Teniente-Sanchez AE, Zapata-Rivera MA, Montes-Villarreal J |title=Pure androgen-secreting adrenal adenoma associated with resistant hypertension |journal=Case Rep Endocrinol |volume=2013 |issue= |pages=356086 |date=2013 |pmid=23819074 |pmc=3681270 |doi=10.1155/2013/356086 |url=}}</ref><ref name="pmid30674304">{{cite journal |vauthors=Zhou WB, Chen N, Li CJ |title=A rare case of pure testosterone-secreting adrenal adenoma in a postmenopausal elderly woman |journal=BMC Endocr Disord |volume=19 |issue=1 |pages=14 |date=January 2019 |pmid=30674304 |pmc=6343319 |doi=10.1186/s12902-019-0342-y |url=}}</ref>
|
* [[Hirsutism]]
* [[Virilization]]
* [[Amenorrhea]]
* [[Precocious puberty]]
* [[Testicular]] [[atrophy]] & diminished [[libido]] ([[male]])
|
* [[Clitorimegaly]]
* [[Male]] pattern [[baldness]]
* [[Resistant hypertension]]
* [[Gynecomastia]]
|
* ↑ [[Serum]] [[testosterone]]
* ↑ [[Serum]] [[androstenedione]]
* ↑ [[Serum]] [[dehydroepiandrosterone sulfate]] ([[DHEA-S]])
* ↑ [[Urine]] 17-ketosteroids
* ↑ [[Plasma]] and [[urine]] [[estrogens]]


*Spindled cell [[stroma]] surrounding abortive tubules and [[Glomerulus|glomeruli]] is characteristic.
*
*The stroma may include:
|
**Striated [[muscle]] [[cartilage]]
* Pale tan to brown
**[[bone]]
* Pseudocapsule or the [[fibrous]] [[capsule]]
**[[Adipose tissue|Fat tissue]]
* Nesting, alveolar, cords, [[trabeculae]]
**[[Fibrous connective tissue|Fibrous tissue.]]
* [[Eosinophilic]] [[cytoplasm]]
* May see clear, vacuolated [[cytoplasm]]
 
*  
|
* [[FSH]], [[LH]], [[prolactin]] levels
* [[Cortisol]] levels
* [[FDG]] [[PET]]/[[CT]]
* [[Pelvic]] [[Ultrasound]]
* [[Adrenal Venous sampling]]
|
* Well-defined
* Solid [[mass]]
|
|
* Homogeneous enhancement ([[CT]] [[contrast]])
|
* N/A
|
* Hyperintense on in-phase and hypointense on oppose-phase
|
* Extremely rare
* Most [[androgen]] secreting [[adenomas]] are mixed [[tumors]]
|-
|-
|2.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Non-functional<br><ref name="pmid26867466">{{cite journal |vauthors=Park JJ, Park BK, Kim CK |title=Adrenal imaging for adenoma characterization: imaging features, diagnostic accuracies and differential diagnoses |journal=Br J Radiol |volume=89 |issue=1062 |pages=20151018 |date=June 2016 |pmid=26867466 |doi=10.1259/bjr.20151018 |url=}}</ref><ref name="pmid27479926">{{cite journal |vauthors=Lopez D, Luque-Fernandez MA, Steele A, Adler GK, Turchin A, Vaidya A |title="Nonfunctional" Adrenal Tumors and the Risk for Incident Diabetes and Cardiovascular Outcomes: A Cohort Study |journal=Ann. Intern. Med. |volume=165 |issue=8 |pages=533–542 |date=October 2016 |pmid=27479926 |pmc=5453639 |doi=10.7326/M16-0547 |url=}}</ref><ref name="pmid20823463">{{cite journal |vauthors=Nieman LK |title=Approach to the patient with an adrenal incidentaloma |journal=J. Clin. Endocrinol. Metab. |volume=95 |issue=9 |pages=4106–13 |date=September 2010 |pmid=20823463 |pmc=2936073 |doi=10.1210/jc.2010-0457 |url=}}</ref><ref name="pmid23255953">{{cite journal |vauthors=Li B, Guo Q, Yang H, Guan J |title=Giant non-functional adrenal adenoma: A case report |journal=Oncol Lett |volume=5 |issue=1 |pages=378–380 |date=January 2013 |pmid=23255953 |pmc=3525484 |doi=10.3892/ol.2012.978 |url=}}</ref>
|[[Renal cell carcinoma]]
|
|<nowiki>+</nowiki>
* Asymptomatic
|<nowiki>+</nowiki>
* [[Abdominal]] [[pain]]
|<nowiki>+/-</nowiki>
* [[Abdominal]] distenstion
|<nowiki>+</nowiki>
* [[Nausea]]/[[vomiting]]
|<nowiki>-</nowiki>
* Sub-clinical [[Cushing syndrome]]
* Sub-clinical [[hyperaldosteronism]]
|
* Asymptomatic
* [[Abdominal]] asymmetry
* [[Abdominal]] [[mass]]
* Sub-clinical [[Cushing syndrome]]
* Sub-clinical [[hyperaldosteronism]]
|
* N/L
* ↓ [[Adrenal]] [[hormones]]
* ↑ [[Serum]] [[cortisol]] (sub-clinical)
* ↑ [[Serum]] [[aldosterone]](sub-clinical)
* ↑ [[Serum]] [[androgens]] (sub-clinical)
|
* Well-defined margins
* Large monomorphic [[cells]]
* Abundant/foamy [[cytoplasm]]
* Typically resemble normal [[adrenal]] [[histology]]
* May see [[hemorrhage]] & [[necrosis]]
|
* [[Adrenal]] [[hormones]] levels
* [[Blood]] [[glucose]] level
* [[Plasma]] [[catecholamines]] and [[urinary]] [[metanephrines]]
* ARR
* [[Immunohistochemical staining]]
|
* Solid, well defined [[mass]]
|
* High [[lipid]] content and adjacent compression
|
|
* [[Ultrasound]] (US) may be helpful when CT scan results are equivocal. It is noteworthy to mention that not all renal cell [[carcinomas]] are detectable on [[ultrasound]].
* N/A
|Both [[CT]] and [[MRI]] may be used to detect [[neoplastic]] masses that may define renal cell carcinoma or metastasis of the primary cancer. [[CT]] scan and use of intravenous (IV) contrast is generally used for work-up and follow-up of patients with [[Renal cell carcinoma|renal cell carcinom]]<nowiki/>a.
|The histological pattern of renal cell [[carcinoma]] depends whether it is [[Papillary|papillary,]] [[chromophobe]] or [[collecting duct]] renal cell carcinoma.
|
|
* Hyperintense on in-phase and hypointense on oppose-phase
|
* 2-fold increased risk for [[Diabetes mellitus]] in some studies
* Work up must exclude [[Cushing syndrome]], [[pheochromocytoma]] and [[adrenal carcinoma]]
|-
|-
|3.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Adrenal [[Adrenal cancer|Carcinoma]]<br><ref name="pmid20823463">{{cite journal |vauthors=Nieman LK |title=Approach to the patient with an adrenal incidentaloma |journal=J. Clin. Endocrinol. Metab. |volume=95 |issue=9 |pages=4106–13 |date=September 2010 |pmid=20823463 |pmc=2936073 |doi=10.1210/jc.2010-0457 |url=}}</ref><ref name="pmid26191527">{{cite journal |vauthors=Libé R |title=Adrenocortical carcinoma (ACC): diagnosis, prognosis, and treatment |journal=Front Cell Dev Biol |volume=3 |issue= |pages=45 |date=2015 |pmid=26191527 |pmc=4490795 |doi=10.3389/fcell.2015.00045 |url=}}</ref><ref name="pmid30306064">{{cite journal |vauthors=Wang F, Liu J, Zhang R, Bai Y, Li C, Li B, Liu H, Zhang T |title=CT and MRI of adrenal gland pathologies |journal=Quant Imaging Med Surg |volume=8 |issue=8 |pages=853–875 |date=September 2018 |pmid=30306064 |pmc=6177362 |doi=10.21037/qims.2018.09.13 |url=}}</ref><ref name="pmid24423978">{{cite journal |vauthors=Else T, Kim AC, Sabolch A, Raymond VM, Kandathil A, Caoili EM, Jolly S, Miller BS, Giordano TJ, Hammer GD |title=Adrenocortical carcinoma |journal=Endocr. Rev. |volume=35 |issue=2 |pages=282–326 |date=April 2014 |pmid=24423978 |pmc=3963263 |doi=10.1210/er.2013-1029 |url=}}</ref><ref name="pmid24102952">{{cite journal |vauthors=Wang C, Sun Y, Wu H, Zhao D, Chen J |title=Distinguishing adrenal cortical carcinomas and adenomas: a study of clinicopathological features and biomarkers |journal=Histopathology |volume=64 |issue=4 |pages=567–76 |date=March 2014 |pmid=24102952 |pmc=4282325 |doi=10.1111/his.12283 |url=}}</ref>
|[[Malignant rhabdoid tumor|Rhabdoid kidney disease]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
| +
* [[Cortisol]]
|<nowiki>+</nowiki>
* [[Aldosterone]]
|<nowiki>-</nowiki>
* [[Androgens]]
|<nowiki>+</nowiki>
* Non-functional
|<nowiki>-</nowiki>
* [[Erythropoietin]]
|
|
* [[Ultrasound]] shows a complex cystic mass.
* Symptoms of [[adrenal]] [[hormones]] excess as mentioned in [[adrenal adenoma]]
* Constitutional [[symptoms]] such as [[cachexia]], [[night sweats]], [[fever]]
* Localized [[symptoms]] such as [[abdominal]] [[pain]], [[mass]], fullness, early [[satiety]]
|
|
* [[CT]] scan may be diagnostic of malignant rhabdoid tumor. Findings on [[CT]] scan suggestive of malignant rhabdoid tumor include a large, heterogenous, centrally located mass, which is lobulated with individual lobules separated by intervening areas of decreased attenuation, relating to either previous [[hemorrhage]] or [[necrosis]]. Enhancement is similarly heterogeneous. [[Calcification]] is relatively common, observed in 20-50% of cases and is typically linear and tends to outline tumor [[lobules]].
* [[Hypertension]]
* Signs of [[Adrenal gland|adrenal hormones]] excess as mentioned in [[adrenal adenoma]]
* Constitutional
* Localized [[signs]] such as [[abdominal]] [[mass]],[[abdominal]] [[distension]]
|
|
* [[Malignant]] rhabdoid tumor is characterized by the round blue tumor cells of high cellularity composed of atypical cells with eccentric nuclei, small nucleoli, and abundant amounts of [[eosinophilic]] cytoplasm with frequent mitotic figures.
* N/L
* ↑ [[Serum]] [[cortisol]]
* ↑ [[Serum]] [[aldosterone]]
* ↑ [[Serum]] [[androgens]] 
* [[Hypokalemia]] 
* [[Alkalosis]]
* ↑ ARR
* ↑ [[Blood]] [[glucose]]
|
|
* Brown to orange to yellow
* [[Necrosis]] & [[mitosis]]
* [[Hypercellular]] & [[solid]] and/or diffuse [[growth]] pattern
* Low to high [[lipid]] content
* [[Nuclear]] [[pleomorphism]]
* Lymphovascular [[invasion]]
|
* [[Serum]] [[ACTH]]
* Low dose and high dose [[dexamethasone suppression test]]
* [[Urinary]] [[adrenal]] [[metabolites]]
* [[Spectroscopy|Proton MR spectroscopy]]
* [<sup>11</sup>C]MTO [[PET]]
* [[Immunohistochemical staining]]
|
* N/A
|
* Heterogeneous enhancement
|
* Heterogeneous mass with intense [[FDG]] uptake greater than [[liver]]
|
* Heterogenous hyper-intensity (T2-weighted) and hypo-intensity on (T1-weighted)
|
* May cause [[hypoglycemia]] (Anderson's syndrome}
* May be associated with:
** [[Hyperreninemic hypoaldosteronism|Hyperreninemic]]
** [[Hyperaldosteronism]]
** [[Erythropoietin]]-associated [[polycythemia]]
** [[Leukocytosis]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Adrenal [[Adrenal hyperplasia|Hyperplasia]]<br><ref name="pmid25958045">{{cite journal |vauthors=Monticone S, Castellano I, Versace K, Lucatello B, Veglio F, Gomez-Sanchez CE, Williams TA, Mulatero P |title=Immunohistochemical, genetic and clinical characterization of sporadic aldosterone-producing adenomas |journal=Mol. Cell. Endocrinol. |volume=411 |issue= |pages=146–54 |date=August 2015 |pmid=25958045 |pmc=4474471 |doi=10.1016/j.mce.2015.04.022 |url=}}</ref><ref name="pmid18493137">{{cite journal |vauthors=Stratakis CA |title=Cushing syndrome caused by adrenocortical tumors and hyperplasias (corticotropin- independent Cushing syndrome) |journal=Endocr Dev |volume=13 |issue= |pages=117–32 |date=2008 |pmid=18493137 |pmc=3132884 |doi=10.1159/000134829 |url=}}</ref><ref name="pmid24605256">{{cite journal |vauthors=Guerrisi A, Marin D, Baski M, Guerrisi P, Capozza F, Catalano C |title=Adrenal lesions: spectrum of imaging findings with emphasis on multi-detector computed tomography and magnetic resonance imaging |journal=J Clin Imaging Sci |volume=3 |issue= |pages=61 |date=2013 |pmid=24605256 |pmc=3935261 |doi=10.4103/2156-7514.124088 |url=}}</ref><ref name="pmid16278716">{{cite journal |vauthors=Arnold DT, Reed JB, Burt K |title=Evaluation and management of the incidental adrenal mass |journal=Proc (Bayl Univ Med Cent) |volume=16 |issue=1 |pages=7–12 |date=January 2003 |pmid=16278716 |pmc=1200803 |doi= |url=}}</ref><ref name="pmid23819074">{{cite journal |vauthors=Rodríguez-Gutiérrez R, Bautista-Medina MA, Teniente-Sanchez AE, Zapata-Rivera MA, Montes-Villarreal J |title=Pure androgen-secreting adrenal adenoma associated with resistant hypertension |journal=Case Rep Endocrinol |volume=2013 |issue= |pages=356086 |date=2013 |pmid=23819074 |pmc=3681270 |doi=10.1155/2013/356086 |url=}}</ref><ref name="pmid30306064">{{cite journal |vauthors=Wang F, Liu J, Zhang R, Bai Y, Li C, Li B, Liu H, Zhang T |title=CT and MRI of adrenal gland pathologies |journal=Quant Imaging Med Surg |volume=8 |issue=8 |pages=853–875 |date=September 2018 |pmid=30306064 |pmc=6177362 |doi=10.21037/qims.2018.09.13 |url=}}</ref><ref name="pmid28707538">{{cite journal |vauthors=Michelle M A, Jensen CT, Habra MA, Menias CO, Shaaban AM, Wagner-Bartak NA, Roman-Colon AM, Elsayes KM |title=Adrenal cortical hyperplasia: diagnostic workup, subtypes, imaging features and mimics |journal=Br J Radiol |volume=90 |issue=1079 |pages=20170330 |date=November 2017 |pmid=28707538 |pmc=5963387 |doi=10.1259/bjr.20170330 |url=}}</ref><ref name="pmid26770569">{{cite journal |vauthors=Zhang Y, Li H |title=Classification and surgical treatment for 180 cases of adrenocortical hyperplastic disease |journal=Int J Clin Exp Med |volume=8 |issue=10 |pages=19311–7 |date=2015 |pmid=26770569 |pmc=4694469 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
* [[Cortisol]] (most common)
* [[Aldosterone]]
* [[Androgens]]
* Non-functional
|
* Depending on the product secreted, may present as:
** [[Cushing syndrome]]
** [[Hyperaldosteronism]]
** [[Virilization]]
** [[Hirsutism]]
** [[Menstrual irregularities]]
** [[Testicular]] [[atrophy]]
** Diminished [[libido]]
* Localized [[symptoms]] such as [[abdominal]] [[pain]], [[mass]], [[fullness]], early [[satiety]]
|
* Depending on the product secreted, may present as:
** [[Cushing syndrome]]
** [[Hyperaldosteronism]]
** [[Virilization]]
** [[Hirsutism]]
** [[Menstrual irregularities]]
** [[Testicular]] [[atrophy]]
** [[Gynecomastia]]
* Localized [[symptoms]] such as [[abdominal]] [[pain]], [[mass]], [[fullness]], early [[satiety]]
|
* ↑ [[Serum]] [[cortisol]]
* ↑ [[Serum]] [[aldosterone]]
* ↑ [[Serum]] [[androgens]] 
* [[Hypokalemia]] 
* [[Alkalosis]]
* ↑ ARR
* ↑ [[Blood]] [[glucose]]
* ↑ [[Serum]] [[testosterone]]
* ↑ [[Serum]] [[androstenedione]]
* ↑ [[Serum]] [[dehydroepiandrosterone sulfate]] ([[DHEA-S]])
* ↑ [[Plasma]] and [[urine]] [[estrogens]]
|
* Diffuse or [[nodular]] enlargement
* Increased thickness of [[zona reticularis]] and [[zona fasciculata]]
* Large polygonal [[cells]] with/without [[lipid]] depletion
* May contain [[pigment]] ([[lipofuscin]])
* [[endocrine]] [[atypia]]
* Small [[nodules]]
|
* [[Adrenal venous sampling]]
* [[Pelvic]] & [[pituitary]] [[imaging]]
* [[Genetic testing]]
* [[Fludrocortisone]] suppression testing
* [[Saline]] infusion testing
* Diurnal [[plasma]] [[cortisol]] variation
* Low dose and high dose [[dexamethasone suppression test]]
* [[FSH]], [[LH]], [[prolactin]] levels
* [[Cortisol]] levels
|
* [[Adrenal]] [[mass]]
* Unilateral or bilateral [[adrenal]] enlargement or thickening
|
* Unilateral or bilateral [[adrenal]] enlargement or thickening
* [[Density]] is same as that of normal [[adrenal gland]]
|
* N/A
|
* Unilateral or bilateral [[adrenal]] enlargement or thickening
* Signaling is same as that of normal [[adrenal gland]]
|
* [[Congenital adrenal hyperplasia]] presents in [[children]]/young adults
* Associated with [[Carney complex]]
* [[Plasma]] levels of [[cortisol]] and [[ACTH]] may show false positive and false negative results due to normal diurnal [[hormonal]] variation
|+
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Medulla
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Product
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Clinical manifestations
! colspan="7" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Signs
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Blood & Urine
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Histopathological
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Others
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Ultrasound
! style="background:#4479BA; color: #FFFFFF;" align="center" + |CT scan
! style="background:#4479BA; color: #FFFFFF;" align="center" + |FDG PET/CT
! style="background:#4479BA; color: #FFFFFF;" align="center" + |MRI
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pheochromocytoma]]<br><ref name="pmid24636754">{{cite journal |vauthors=Martucci VL, Pacak K |title=Pheochromocytoma and paraganglioma: diagnosis, genetics, management, and treatment |journal=Curr Probl Cancer |volume=38 |issue=1 |pages=7–41 |date=2014 |pmid=24636754 |pmc=3992879 |doi=10.1016/j.currproblcancer.2014.01.001 |url=}}</ref><ref name="pmid20541673">{{cite journal |vauthors=Kantorovich V, Pacak K |title=Pheochromocytoma and paraganglioma |journal=Prog. Brain Res. |volume=182 |issue= |pages=343–73 |date=2010 |pmid=20541673 |pmc=4714594 |doi=10.1016/S0079-6123(10)82015-1 |url=}}</ref><ref name="pmid19605896">{{cite journal |vauthors=Miller AD, Masek-Hammerman K, Dalecki K, Mansfield KG, Westmoreland SV |title=Histologic and immunohistochemical characterization of pheochromocytoma in 6 cotton-top tamarins (Saguinus oedipus) |journal=Vet. Pathol. |volume=46 |issue=6 |pages=1221–9 |date=November 2009 |pmid=19605896 |doi=10.1354/vp.09-VP-0022-M-FL |url=}}</ref><ref name="pmid19120142">{{cite journal |vauthors=Kantorovich V, Eisenhofer G, Pacak K |title=Pheochromocytoma: an endocrine stress mimicking disorder |journal=Ann. N. Y. Acad. Sci. |volume=1148 |issue= |pages=462–8 |date=December 2008 |pmid=19120142 |pmc=2693284 |doi=10.1196/annals.1410.081 |url=}}</ref><ref name="pmid25332315">{{cite journal |vauthors=Eisenhofer G, Peitzsch M |title=Laboratory evaluation of pheochromocytoma and paraganglioma |journal=Clin. Chem. |volume=60 |issue=12 |pages=1486–99 |date=December 2014 |pmid=25332315 |doi=10.1373/clinchem.2014.224832 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
* [[Catecholamines]]
|
*[[Headaches]]
*[[Palpitations]]
*Excessive [[sweating]]
*[[Anxiety]]
*[[Pallor]]
*Pain in [[chest]]/[[abdomen]]
*[[Weakness]], [[fatigue]]
*[[Nausea]]/[[vomiting]]
*[[Dizziness]]
*[[Paresthesias]]
*[[Constipation]] (rarely [[diarrhea]])
*[[Visual disturbance]]
|
*[[Hypertension]]
*Postural [[hypotension]]
*[[Tachycardia]] or reflex [[bradycardia]]
*Tremulousness
*[[Pallor]]
*[[Flushing]] (rare)
*[[Weight]] loss
*Fasting [[hyperglycaemia]]
*Decreased [[GI]] [[motility]]
*[[Pallor]]
*↑ [[Respiratory rate]]
*[[Psychosis]]
|
* ↑ [[Plasma]] and [[urine]] [[catecholamines]] (Gold standard)
* ↑ [[Plasma]] and [[urine]] [[metanephrines]] (Gold standard)
* ↑ [[Chromogranin A]]
* ↑ [[Plasma]] [[methoxytyramine]]
|
*Loosely cohesive clusters
*Scattered [[tumor]] [[cells]] with prominent anisokaryosis, abundant [[eosinophilic]] granular [[cytoplasm]] and indistinct [[cell]] borders
*Occasional bi-nucleate [[cells]]
|
*Genetic testing
*Provacative [[glucagon]] test
*[[Clonidine]] suppression test
*Metaiodobenzyl-guanidine [[scintigraphy]]
*[[PET]] scan
*[[Octereoscan]]
|
*[[Cystic]] or solid with [[necrotic]] areas or [[hemorrhages]]
|
* Heterogeneous appearance, often with some [[cystic]] areas.
* [[Calcification]] or [[hemorrhage]] may also be present
|
* N/A
|
* T2-bright lesions, with/without [[cystic]] or [[necrotic]] components
|
*May mimic [[panic attack]]
*May be associated with  [[Von Hippel-Lindau disease]],  [[MEN type 2]] and [[neurofibromatosis type 1]].
*Arise from the [[chromaffin cells]]
*[[Stain|Stains]] positive for
** [[Chromogranin A]] (CGA)
** Protein gene product (PGP) 9.5
** [[Synaptophysin]] (SYN)
** [[CD56]] ([[CAM|N-CAM]])
** [[Glial fibrillary acidic protein]] ([[GFAP]])
|-
|-
|4.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neuroblastoma]]<br><ref name="pmid30306064">{{cite journal |vauthors=Wang F, Liu J, Zhang R, Bai Y, Li C, Li B, Liu H, Zhang T |title=CT and MRI of adrenal gland pathologies |journal=Quant Imaging Med Surg |volume=8 |issue=8 |pages=853–875 |date=September 2018 |pmid=30306064 |pmc=6177362 |doi=10.21037/qims.2018.09.13 |url=}}</ref><ref name="pmid25154816">{{cite journal |vauthors=Vo KT, Matthay KK, Neuhaus J, London WB, Hero B, Ambros PF, Nakagawara A, Miniati D, Wheeler K, Pearson AD, Cohn SL, DuBois SG |title=Clinical, biologic, and prognostic differences on the basis of primary tumor site in neuroblastoma: a report from the international neuroblastoma risk group project |journal=J. Clin. Oncol. |volume=32 |issue=28 |pages=3169–76 |date=October 2014 |pmid=25154816 |pmc=4171360 |doi=10.1200/JCO.2014.56.1621 |url=}}</ref><ref name="pmid25254086">{{cite journal |vauthors=Bordbar M, Tasbihi M, Kamfiroozi R, Haghpanah S |title=Epidemiological and clinical characteristics of neuroblastoma in southern iran |journal=Iran J Ped Hematol Oncol |volume=4 |issue=3 |pages=89–96 |date=2014 |pmid=25254086 |pmc=4173027 |doi= |url=}}</ref><ref name="pmid24563879">{{cite journal |vauthors=Skoura E, Oikonomopoulos G, Vasileiou S, Kyprianou D, Koumakis G, Datseris IE |title=(18)F-FDG-PET/CT, (123)I-MIBG and (99m)Tc-MDP whole-body scans, in detecting recurrence of an adult adrenal neuroblastoma |journal=Hell J Nucl Med |volume=17 |issue=1 |pages=58–61 |date=2014 |pmid=24563879 |doi=10.1967/s002449910116 |url=}}</ref>
|[[Polycystic kidney disease]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
|<nowiki>+</nowiki>
* [[Catecholamines]]
|<nowiki>+</nowiki>
|
|<nowiki>+ (from hypertension)</nowiki>
* Constitutional
|<nowiki>+</nowiki>
* Failure to thrive
|<nowiki>-</nowiki>
* [[Abdominal]] [[pain]]
* [[Diarrhea]]
* [[Constipation]]
* [[Dyspnea]]
* Prolonged [[cough]]
* [[Strabismus]]
* [[Proptosis]]
|
* [[Abdominal]] [[mass]]
* [[Pallor]]
* [[Tachycardia]]
* [[Hypertension]]
* Failure to thrive
* [[Strabismus]]
* [[Proptosis]]
|
* N/L
* Slight elevation in [[catecholamines]]
* ↑ [[Urinary]] [[metanephrines]]
* [[Anemia]]
* ↑ [[Ferritin]]
* ↑ [[LDH]]
* [[Thrombocytosis]]
|
|
Ultrasound may be helpful in the diagnosis of polycystic kidney disease. Findings on an ultrasound diagnostic of polycystic kidney disease include:<ref name="pmid25786098">{{cite journal |vauthors=Chapman AB, Devuyst O, Eckardt KU, Gansevoort RT, Harris T, Horie S, Kasiske BL, Odland D, Pei Y, Perrone RD, Pirson Y, Schrier RW, Torra R, Torres VE, Watnick T, Wheeler DC |title=Autosomal-dominant polycystic kidney disease (ADPKD): executive summary from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference |journal=Kidney Int. |volume=88 |issue=1 |pages=17–27 |date=July 2015 |pmid=25786098 |pmc=4913350 |doi=10.1038/ki.2015.59 |url=}}</ref><ref name="pmid18945943">{{cite journal |vauthors=Pei Y, Obaji J, Dupuis A, Paterson AD, Magistroni R, Dicks E, Parfrey P, Cramer B, Coto E, Torra R, San Millan JL, Gibson R, Breuning M, Peters D, Ravine D |title=Unified criteria for ultrasonographic diagnosis of ADPKD |journal=J. Am. Soc. Nephrol. |volume=20 |issue=1 |pages=205–12 |date=January 2009 |pmid=18945943 |pmc=2615723 |doi=10.1681/ASN.2008050507 |url=}}</ref>
* Pathological examinations are gold standard.
*At least three unilateral or bilateral [[cysts]] in patients 15 - 39 years old
* Cells may show:
*Atleast two [[cysts]] in each [[kidney]] in patients 40 - 59 years old
** Undifferentiation
*Atleast four [[cysts]] in each [[kidney]] in patients 60 years of age or older
** Poor differentiation
** Differentiating [[neuroblasts]]
* [[Necrosis]]
* Salt and pepper [[chromatin]]
* [[Spindle]]-like [[fibers]]
|
|
[[Renal]] CT scan may be helpful in the diagnosis of polycystic kidney disease. Findings on CT scan diagnostic of ADPKD include:
* [[Immunohistochemical staining]]
* Numerous [[renal]] [[cysts]] of varying size and shape with little intervening [[parenchyma]] with water [[attenuation]] and very thin wall.
* [[PET]] scan
* Reduction in [[sinus]] [[fat]] due to expansion of the [[cortex]]
*[[Octereoscan]]
* Occasional complex [[cysts]] with hyperdense appearance, with possible septations or calcifications
*<sup>131</sup>I-metaiodobenzylguanidine (MIBG) [[scintigraphy]]
* Multiple [[homogeneous]] and hypoattenuating [[cystic]] lesions in the [[liver]] in patients with [[liver]] involvement
*[[FISH]]
*[[Genetic testing]]
|
|
*On microscopic histopathological analysis, interstitial fibrosis, tubular atrophy, thickening and lamellation of tubular basement membranes, microcysts and negative immunofluorescence for complement and immunoglobulin are characteristic findings of ADPKD.<ref name="pmid12234310">{{cite journal |vauthors=Stavrou C, Koptides M, Tombazos C, Psara E, Patsias C, Zouvani I, Kyriacou K, Hildebrandt F, Christofides T, Pierides A, Deltas CC |title=Autosomal-dominant medullary cystic kidney disease type 1: clinical and molecular findings in six large Cypriot families |journal=Kidney Int. |volume=62 |issue=4 |pages=1385–94 |date=October 2002 |pmid=12234310 |doi=10.1111/j.1523-1755.2002.kid581.x |url=}}</ref><ref name="pmid24509297">{{cite journal |vauthors=Bleyer AJ, Kmoch S, Antignac C, Robins V, Kidd K, Kelsoe JR, Hladik G, Klemmer P, Knohl SJ, Scheinman SJ, Vo N, Santi A, Harris A, Canaday O, Weller N, Hulick PJ, Vogel K, Rahbari-Oskoui FF, Tuazon J, Deltas C, Somers D, Megarbane A, Kimmel PL, Sperati CJ, Orr-Urtreger A, Ben-Shachar S, Waugh DA, McGinn S, Bleyer AJ, Hodanová K, Vylet'al P, Živná M, Hart TC, Hart PS |title=Variable clinical presentation of an MUC1 mutation causing medullary cystic kidney disease type 1 |journal=Clin J Am Soc Nephrol |volume=9 |issue=3 |pages=527–35 |date=March 2014 |pmid=24509297 |pmc=3944763 |doi=10.2215/CJN.06380613 |url=}}</ref><ref name="pmid21775974">{{cite journal |vauthors=Faguer S, Decramer S, Chassaing N, Bellanné-Chantelot C, Calvas P, Beaufils S, Bessenay L, Lengelé JP, Dahan K, Ronco P, Devuyst O, Chauveau D |title=Diagnosis, management, and prognosis of HNF1B nephropathy in adulthood |journal=Kidney Int. |volume=80 |issue=7 |pages=768–76 |date=October 2011 |pmid=21775974 |doi=10.1038/ki.2011.225 |url=}}</ref><ref name="pmid20378641">{{cite journal |vauthors=Heidet L, Decramer S, Pawtowski A, Morinière V, Bandin F, Knebelmann B, Lebre AS, Faguer S, Guigonis V, Antignac C, Salomon R |title=Spectrum of HNF1B mutations in a large cohort of patients who harbor renal diseases |journal=Clin J Am Soc Nephrol |volume=5 |issue=6 |pages=1079–90 |date=June 2010 |pmid=20378641 |pmc=2879303 |doi=10.2215/CJN.06810909 |url=}}</ref>
* Large mass
* May cross midline
|
* Large mass extending across the midline
* Heterogeneous enhancement
* [[Calcification]] & [[hemorrhage]]
|
* N/A
|
* [[Calcification]] & [[hemorrhage]]
* Non-homogeneous and hyperintense
* Hypointense (T1-weighted)
|[[Stain|Stains]] positive for:
* [[Chromogranin A]] (CGA)
* Protein gene product (PGP) 9.5
* [[Neuron-specific enolase]]
* [[Synaptophysin]] ([[Synaptophysin|SYN]])
* [[CD56]] & [[CD57]]
* [[Glial fibrillary acidic protein]] ([[GFAP]])


*
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ganglioneuroma]]<br><ref name="pmid30306064">{{cite journal |vauthors=Wang F, Liu J, Zhang R, Bai Y, Li C, Li B, Liu H, Zhang T |title=CT and MRI of adrenal gland pathologies |journal=Quant Imaging Med Surg |volume=8 |issue=8 |pages=853–875 |date=September 2018 |pmid=30306064 |pmc=6177362 |doi=10.21037/qims.2018.09.13 |url=}}</ref><ref name="pmid29085827">{{cite journal |vauthors=Mylonas KS, Schizas D, Economopoulos KP |title=Adrenal ganglioneuroma: What you need to know |journal=World J Clin Cases |volume=5 |issue=10 |pages=373–377 |date=October 2017 |pmid=29085827 |pmc=5648998 |doi=10.12998/wjcc.v5.i10.373 |url=}}</ref><ref name="pmid24779851">{{cite journal |vauthors=Adas M, Koc B, Adas G, Ozulker F, Aydin T |title=Ganglioneuroma presenting as an adrenal incidentaloma: a case report |journal=J Med Case Rep |volume=8 |issue= |pages=131 |date=April 2014 |pmid=24779851 |pmc=4031973 |doi=10.1186/1752-1947-8-131 |url=}}</ref><ref name="pmid23661526">{{cite journal |vauthors=Li J, Yang CH, Li LM |title=Diagnosis and treatment of 29 cases of adrenal ganglioneuroma |journal=Eur Rev Med Pharmacol Sci |volume=17 |issue=8 |pages=1110–3 |date=April 2013 |pmid=23661526 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
* [[Catecholamines]]
* [[VIP]]
* [[Cortisol]]
* [[Androgens]]
|
* Asymptomatic
* [[Abdominal]] [[pain]]
* [[Diarrhea]]
|
* N/L
* [[Abdominal]] [[mass]]
* [[Hypertension]]
|
* N/L
* ↑ [[Plasma]] and [[urinary]] [[catecholamine]]
* ↑ [[VIP]]
* ↑ [[Cortisol]] and [[testosterone]]
|
* Pathological examinations are gold standard.
* Mature type: mature [[Schwann cells]], [[ganglion cells]] and peri-[[neural]] [[cells]]
* Maturing type: [[Schwann cells]], [[ganglion cells]] and peri-[[neural]] [[cells]] with varying [[maturation]]
|
* Pathological examinations are gold standard.
* [[Ultrasound]]
* [[Immunohistochemical staining]]
* <sup>18</sup>F-2-fluoro-deoxy-D-glucose-[[positron emission tomography]] ([[PET]])
|
* N/A
|
* Well-defined, Homogeneous
* Punctate or discrete [[calcification]]
|
* N/A
|
* Hypointense (T1-weighted)
* Varied signal (T2-weighted)
|
|
[[Stain|Stains]] positive for:
* [[S-100|S100]]
* [[Synaptophysin]]
* [[Neurofilament]] ([[NF]]) [[protein]]
* [[Chromogranin A]]
* [[Glial fibrillary acidic protein]]
* PGP 9.5
* [[Type IV collagen]]
* [[VIP]]
|+
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Stroma
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Product
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Clinical manifestations
! colspan="7" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
|-
|-
|5.
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
|[[Pheochromocytoma]]
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Signs
|<nowiki>-</nowiki>
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Blood & Urine
|<nowiki>-</nowiki>
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Histopathological
|<nowiki>+ (as a part of the hypertension paroxysm)</nowiki>
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Others
|<nowiki>-</nowiki>
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Ultrasound
|<nowiki>-</nowiki>
! style="background:#4479BA; color: #FFFFFF;" align="center" + |CT scan
! style="background:#4479BA; color: #FFFFFF;" align="center" + |FDG PET/CT
! style="background:#4479BA; color: #FFFFFF;" align="center" + |MRI
|+
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lipoma]]/[[Myolipoma]]<br><ref name="pmid30306064">{{cite journal |vauthors=Wang F, Liu J, Zhang R, Bai Y, Li C, Li B, Liu H, Zhang T |title=CT and MRI of adrenal gland pathologies |journal=Quant Imaging Med Surg |volume=8 |issue=8 |pages=853–875 |date=September 2018 |pmid=30306064 |pmc=6177362 |doi=10.21037/qims.2018.09.13 |url=}}</ref><ref name="pmid11533079">{{cite journal |vauthors=Lam KY, Lo CY |title=Adrenal lipomatous tumours: a 30 year clinicopathological experience at a single institution |journal=J. Clin. Pathol. |volume=54 |issue=9 |pages=707–12 |date=September 2001 |pmid=11533079 |pmc=1731508 |doi= |url=}}</ref><ref name="pmid24328509">{{cite journal |vauthors=Gershuni VM, Bittner JG, Moley JF, Brunt LM |title=Adrenal myelolipoma: operative indications and outcomes |journal=J Laparoendosc Adv Surg Tech A |volume=24 |issue=1 |pages=8–12 |date=January 2014 |pmid=24328509 |pmc=3931430 |doi=10.1089/lap.2013.0411 |url=}}</ref><ref name="pmid26464739">{{cite journal |vauthors=Luo J, Chen L, Wen Q, Xu L, Chu S, Wang W, Alnemah MM, Fan S |title=Lipoadenoma of the adrenal gland: report of a rare entity and review of literature |journal=Int J Clin Exp Pathol |volume=8 |issue=8 |pages=9693–7 |date=2015 |pmid=26464739 |pmc=4583971 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
* N/A
|
|
* CT is the preferred imaging modality for the diagnosis of pheochromocytoma.
* Asymptomatic
|The following findings may be observed on [[CT scan]]:<ref name="pmid1787652">{{cite journal| author=Bravo EL| title=Pheochromocytoma: new concepts and future trends. | journal=Kidney Int | year= 1991 | volume= 40 | issue= 3 | pages= 544-56 | pmid=1787652 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1787652  }}</ref>
* [[Abdominal]] [[pain]]
*Most common extra-[[Adrenal gland|adrenal]] locations are superior and inferior [[abdominal]] [[Paraaortic lymph node|paraaortic]] areas, the [[urinary bladder]], [[thorax]], [[head]], [[neck]] and [[pelvis]].<ref name="pmid1729490">{{cite journal| author=Whalen RK, Althausen AF, Daniels GH| title=Extra-adrenal pheochromocytoma. | journal=J Urol | year= 1992 | volume= 147 | issue= 1 | pages= 1-10 | pmid=1729490 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1729490  }}</ref>
* Back [[pain]]
* [[Fever]]
|
* N/L
* [[Abdominal]] [[mass]]
* [[Fever]]
|
* N/L
|
* Pathological examinations are gold standard.
* Yellow [[adipose tissue]]
* [[Hemorrhagic]] foci
* Islands of [[Hematopoiesis lineages|hematopoietic cells]] ([[myolipoma]]) and mature [[fat cells]] ([[Lipoma]])
|
* [[Renal function tests|RFTs]]
* [[LFTs]]
* [[Urinalysis|Urine analysis]]
* [[Ultrasound]]
|
* Heterogeneous [[mass]]
|
* [[Retro-peritoneal]] [[mass]]
* Well-defined heterogenous enhancement
|
* N/A
|
* High signal
|
* [[Myolipoma]]: mature [[adipose tissue]] and [[haematopoietic]]  elements
* [[Lipoma]]: mature [[fat cells]]
|+
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Others
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Product
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Clinical manifestations
! colspan="7" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Signs
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Blood & Urine
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Histopathological
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Others
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Ultrasound
! style="background:#4479BA; color: #FFFFFF;" align="center" + |CT scan
! style="background:#4479BA; color: #FFFFFF;" align="center" + |FDG PET/CT
! style="background:#4479BA; color: #FFFFFF;" align="center" + |MRI
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tuberculosis]]<br><ref name="pmid27006656">{{cite journal |vauthors=Rodríguez-Gutiérrez R, Rendon A, Barrera-Sánchez M, Carlos-Reyna KE, Álvarez-Villalobos NA, González-Saldivar G, González-González JG |title=Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test |journal=Int J Endocrinol |volume=2016 |issue= |pages=9051865 |date=2016 |pmid=27006656 |pmc=4781954 |doi=10.1155/2016/9051865 |url=}}</ref><ref name="pmid15451821">{{cite journal |vauthors=Haddara WM, van Uum SH |title=TB and adrenal insufficiency |journal=CMAJ |volume=171 |issue=7 |pages=710; author reply 710–1 |date=September 2004 |pmid=15451821 |pmc=517840 |doi=10.1503/cmaj.1041046 |url=}}</ref><ref name="pmid26516430">{{cite journal |vauthors=Huang YC, Tang YL, Zhang XM, Zeng NL, Li R, Chen TW |title=Evaluation of primary adrenal insufficiency secondary to tuberculous adrenalitis with computed tomography and magnetic resonance imaging: Current status |journal=World J Radiol |volume=7 |issue=10 |pages=336–42 |date=October 2015 |pmid=26516430 |pmc=4620114 |doi=10.4329/wjr.v7.i10.336 |url=}}</ref><ref name="pmid28233510">{{cite journal |vauthors=Vinnard C, Blumberg EA |title=Endocrine and Metabolic Aspects of Tuberculosis |journal=Microbiol Spectr |volume=5 |issue=1 |pages= |date=January 2017 |pmid=28233510 |doi=10.1128/microbiolspec.TNMI7-0035-2016 |url=}}</ref><ref name="pmid23687365">{{cite journal |vauthors=Rajasekharan C, Ajithkumar S, Anto V, Parvathy R |title=Extrapulmonary disseminated tuberculosis with tuberculous adrenalitis: a stitch in time saves nine |journal=BMJ Case Rep |volume=2013 |issue= |pages= |date=May 2013 |pmid=23687365 |doi=10.1136/bcr-2012-008011 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
* N/A
|
* [[Weakness]]
* [[Malaise]]
* [[Nausea]]
* [[Fatigue]]
* [[Anorexia]]
* [[Abdominal]] [[pain]]
* [[Orthostatic hypotension]]
* [[Constipation]]
* [[Salt]] craving
* [[Adrenal crisis]]
* [[Symptoms]] of [[pulmonary]] [[TB]]
|
* [[Weight loss]]
* [[Hyperpigmentation]] of the [[skin]]
* [[Fever]]
* [[Hypotension]]
* [[Adrenal crisis]]
* [[Signs]] of [[pulmonary tuberculosis]]
|
* [[Anemia]]
* [[Leukocytosis]]
* [[Hyponatremia]]
* [[Hyperkalemia]]
* [[Hypoglycemia]]
* Low early morning [[serum]] [[cortisol]] levels
* Low basal [[urinary]] [[cortisol]]
* ↑ [[ACTH]]
* ↓ [[Aldosterone]]
* ↑ [[Plasma]] [[renin]]
|
* Enlarged, [[necrotic]] [[adrenal glands]]
* Central [[caseous necrosis]]
* Rim of [[granulomatous]] [[inflammatory cells]] ([[Langerhans giant cells]] and [[lymphocytes]])
* Identifiable [[Acid fast|acid-fast stain]]-positive [[bacteria]] with [[Ziehl-Neelsen stain|Ziehl-Neelsen]] or [[Immunofluorescence|fluorescent stains]]
|
* [[Laparoscopic]] [[adrenalectomy]]
* [[Chest X-ray]]
* [[Chest]] [[CT scan]]
* [[Tuberculin test]]
* [[ACTH]] stimulation test
* [[Insulin]] induced [[hypoglycemia]]
* [[Metyrapone]] stimulation tests
|
* Variable
|
* [[Calcification]]
* Hypodense areas
* Rim enhancement
|
* High [[FDG]] uptake by [[adrenal glands]]
|
* [[Calcification]]
* Variable signals
|
* Majority of the cases are secondary to:
** [[Pulmonary TB]]
** [[Genitourinary]] [[TB]]
** [[HIV]] [[infection]]
* May present with [[shock]] with severe [[hypotension]] and [[hypoglycemia]] due to [[glucocorticoid]] insufficiency
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Histoplasmosis]]<br><ref name="pmid27995051">{{cite journal |vauthors=Rog CJ, Rosen DG, Gannon FH |title=Bilateral adrenal histoplasmosis in an immunocompetent man from Texas |journal=Med Mycol Case Rep |volume=14 |issue= |pages=4–7 |date=December 2016 |pmid=27995051 |pmc=5154969 |doi=10.1016/j.mmcr.2016.11.006 |url=}}</ref><ref name="pmid27047312">{{cite journal |vauthors=Wahab NA, Mohd R, Zainudin S, Kamaruddin NA |title=Adrenal involvement in histoplasmosis |journal=EXCLI J |volume=12 |issue= |pages=1–4 |date=2013 |pmid=27047312 |pmc=4817423 |doi= |url=}}</ref><ref name="pmid29888193">{{cite journal |vauthors=May D, Khaled D, Gills J |title=Unilateral adrenal histoplasmosis |journal=Urol Case Rep |volume=19 |issue= |pages=54–56 |date=July 2018 |pmid=29888193 |pmc=5991316 |doi=10.1016/j.eucr.2018.03.010 |url=}}</ref><ref name="pmid29643659">{{cite journal |vauthors=Gupta RK, Majumdar K, Srivastava S, Varakanahalli S, Saran RK |title=Endoscopic Ultrasound-guided Cytodiagnosis of Adrenal Histoplasmosis with Reversible CD4 T-Lymphocytopenia and Jejunal Lymphangiectasia |journal=J Cytol |volume=35 |issue=2 |pages=110–113 |date=2018 |pmid=29643659 |pmc=5885598 |doi=10.4103/JOC.JOC_234_15 |url=}}</ref><ref name="pmid25027093">{{cite journal |vauthors=Padma S, Sreehar S |title=18F FDG PET/CT identifies unsuspected bilateral adrenal histoplasmosis in an elderly immuno compromised patient |journal=Indian J. Med. Res. |volume=139 |issue=5 |pages=786–7 |date=May 2014 |pmid=25027093 |pmc=4140048 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
* N/A
|
* No [[adrenal]] s[[ymptoms]]
* [[Adrenal insufficiency]]:
** [[Weakness]] & [[malaise]]
** [[Nausea]], [[fatigue]] and [[anorexia]]
** [[Abdominal]] [[pain]]
** [[Orthostatic hypotension]]
** [[Constipation]]
** [[Salt]] craving
* [[Symptoms]] of [[pulmonary]]/[[skin]]/[[bone]] [[histoplasmosis]]
|
* [[Weight loss]]
* [[Hyperpigmentation]] of the [[skin]]
* [[Fever]]
* [[Hypotension]]
* [[Adrenal crisis]]
* [[Signs]] of [[pulmonary]]/[[skin]]/[[bone]] [[histoplasmosis]]
|
* [[Anemia]]
* [[Leukocytosis]]
* [[Hyponatremia]]
* [[Hyperkalemia]]
* [[Hypoglycemia]]


*In sporadic pheochromocytoma, [[CT]] and [[MRI]] are good choices. The choice depends on availability and cost.<ref name="pmid191248172">{{cite journal| author=Baid SK, Lai EW, Wesley RA, Ling A, Timmers HJ, Adams KT et al.| title=Brief communication: radiographic contrast infusion and catecholamine release in patients with pheochromocytoma. | journal=Ann Intern Med | year= 2009 | volume= 150 | issue= 1 | pages= 27-32 | pmid=19124817 | doi= | pmc=3490128 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19124817  }}</ref>
* Low early morning [[serum]] [[cortisol]] levels
*In patients with the [[multiple endocrine neoplasia]] type 2 ([[Multiple endocrine neoplasia type 2|MEN2]]) syndrome, [[CT]] may miss the [[tumors]].<ref name="pmid17876522">{{cite journal| author=Bravo EL| title=Pheochromocytoma: new concepts and future trends. | journal=Kidney Int | year= 1991 | volume= 40 | issue= 3 | pages= 544-56 | pmid=1787652 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1787652  }}</ref>
* Low basal [[urinary]] [[cortisol]]
* ↑ [[ACTH]]
* ↓ [[Aldosterone]]
* ↑ [[Plasma]] [[renin]]
|
* [[Necrotizing]] [[granulomatous]] [[inflammation]] similar to [[tuberculosis]]
* [[Capsulated]] [[yeast]] forms of ''[[Histoplasma]]'' ([[Giemsa stain]])
* ''[[Histoplasma]]'' identification ([[H&E stain]])
* Focal ovoid bodies with a clear halo ([[PAS stain]])
|
* [[Ultrasound]]-guided [[fine needle aspiration]] [[cytology]] ([[Ultrasound|USG]]-[[FNA|FNAC]]) is gold standard.
* [[Laparoscopic]] [[adrenalectomy]]
* [[Endoscopic ultrasound]]
* [[Ultrasound|Abdominal ultrasound]]
* [[Chest X-ray]]
* [[ACTH]] stimulation test
* [[Metyrapone]] stimulation tests
|
|
* On microscopic pathology, [[Pheochromocytoma]] typically demonstrates a nesting (Zellballen) pattern on microscopy. This pattern is composed of well-defined clusters of tumor cells containing [[eosinophilic]] cytoplasm separated by fibrovascular [[stroma]].
* Enlarged [[adrenal glands]]
* [[Calcification]]
|
|
* Enlarged [[adrenal glands]]
* [[Calcification]]
* Heterogeneous enhancement
|
* Abnormal [[FDG]] uptake by [[adrenal glands]]
|
* Enlarged [[adrenal glands]]
* [[Calcification]]
* Isointense [[adrenal]] [[mass]] ([[MRI]])
|
* [[Patient]] may exhibit no [[clinical manifestations]] of [[adrenal]] involvement
* Majority of the cases are secondary to:
** [[Pulmonary]] [[histoplasmosis]]
** [[HIV]] [[infection]]
* May present with [[shock]] with severe [[hypotension]] and [[hypoglycemia]] due to [[glucocorticoid]] insufficiency
|-
|-
|6.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cysts]]<br><ref name="pmid30306064">{{cite journal |vauthors=Wang F, Liu J, Zhang R, Bai Y, Li C, Li B, Liu H, Zhang T |title=CT and MRI of adrenal gland pathologies |journal=Quant Imaging Med Surg |volume=8 |issue=8 |pages=853–875 |date=September 2018 |pmid=30306064 |pmc=6177362 |doi=10.21037/qims.2018.09.13 |url=}}</ref><ref name="pmid28246490">{{cite journal |vauthors=Carsote M, Ghemigian A, Terzea D, Gheorghisan-Galateanu AA, Valea A |title=Cystic adrenal lesions: focus on pediatric population (a review) |journal=Clujul Med |volume=90 |issue=1 |pages=5–12 |date=2017 |pmid=28246490 |doi=10.15386/cjmed-677 |url=}}</ref><ref name="pmid26807295">{{cite journal |vauthors=Słapa RZ, Jakubowski WS, Dobruch-Sobczak K, Kasperlik-Załuska AA |title=Standards of ultrasound imaging of the adrenal glands |journal=J Ultrason |volume=15 |issue=63 |pages=377–87 |date=December 2015 |pmid=26807295 |pmc=4710689 |doi=10.15557/JoU.2015.0035 |url=}}</ref><ref name="pmid29881567">{{cite journal |vauthors=Olaoye IO, Adesina MD, Afolayan EA |title=A giant adrenal cyst with an uncertain preoperative diagnosis causing a dilemma in management |journal=Clin Case Rep |volume=6 |issue=6 |pages=1074–1076 |date=June 2018 |pmid=29881567 |pmc=5986023 |doi=10.1002/ccr3.1519 |url=}}</ref>
|[[Burkitt's lymphoma|Burkitt lymphoma]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
|<nowiki>+/- (in non-endemic or sporadic form of the disease)</nowiki>
* N/A
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
* [[Abdominal]] [[pain]]
|<nowiki>-</nowiki>
* [[Abdominal Aortic Aneurysm|Abdominal]] [[mass]]
|<nowiki>-</nowiki>
* [[Abdominal]] fullness
* [[Hematuria]]
* [[Infection]]
* [[Symptoms]] of [[malignancy]] ([[Cystic]] part of other [[tumors]])
|
* [[Abdominal]] [[mass]] & assymetry
* [[Fever]]
* [[Hypertension]] ([[Renal]] compression)
* [[Hypotension]] ([[Hemorrhage]] into [[cyst]])
* [[Signs]] of [[malignancy]] ([[Cystic]] part of other [[tumors]])
|
|
* Abdominal [[ultrasonography]] may show [[splenomegaly]] and [[ascites]].
* N/L
* [[Anemia]]
* [[Leukocytosis]]  
|
|
* Chest, abdomen, and pelvis [[CT]] scan may be helpful in the diagnosis of [[Burkitt's lymphoma]] but it is not done routinely.<ref name="medlineplus">Burkitt lymphoma. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/001308.htm Accessed on September 30, 2015</ref>
* [[Vascular]] or [[endothelial]] [[cyst]]: lined by flattened [[endothelial cells]]
* [[Epithelial]]: lined by [[epithelium]]
* [[Pseudocyst]]: lined by [[fibrous tissue]]
* [[Hydatid cyst]]: 3 layers (germinal layer, laminated [[membrane]] and dense [[fibrovascular tissue]])
|
|
*On microscopic histopathological analysis, characteristic findings of Burkitt's lymphoma include:<ref name="pmid12610094">{{cite journal |author=Bellan C, Lazzi S, De Falco G, Nyongo A, Giordano A, Leoncini L |title=Burkitt's lymphoma: new insights into molecular pathogenesis |journal=J. Clin. Pathol. |volume=56 |issue=3 |pages=188–92 |year=2003 |month=March |pmid=12610094 |pmc=1769902 |doi= |url=http://jcp.bmj.com/cgi/pmidlookup?view=long&pmid=12610094}}</ref>
* Complete [[endocrine]] panel
:*Medium-sized (~1.5-2x the size of a RBC) with uniform size ("monotonous") -- '''key feature''' (i.e. tumor nuclei size similar to that of [[histiocytes]] or [[endothelial cells]])
* [<sup>18</sup>F][[FDG]] [[PET]]/[[CT]] (if [[malignancy]] is suspected)
:*Round nucleus
* [[Biopsy]] (if [[malignancy]] is suspected)
:*Small nucleoli
* [[ACTH]] stimulation test
:*Relatively abundant cytoplasm ([[basophilic]])
:*Brisk mitotic rate and [[apoptotic]] activity
:*Cellular outline usually appears squared off
:*"Starry-sky pattern":
::*The ''stars'' in the pattern are tingible-body macrophages (macrophages containing [[apoptotic]] tumor cells.
::*The tumour cells are the ''sky''
|
|
* Gold standard
* Circumscribed anechoic or hypoechoic mass
|
* Homogeneous [[mass]]
* No enhancement
* [[Calcification]]
* Low density
|
* N/A
|
* High signal
|
* 3 major subtypes
** Pure [[cysts]] ([[vascular]] or [[endothelial]] [[cyst]], [[pseudocyst]] and 'true' [[epithelial]] [[cysts]])
** [[Parasitic cysts]]
** [[Cystic]] part of an otherwise solid [[tumor]]
|-
|-
|7.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematoma]]<br><ref name="pmid30306064">{{cite journal |vauthors=Wang F, Liu J, Zhang R, Bai Y, Li C, Li B, Liu H, Zhang T |title=CT and MRI of adrenal gland pathologies |journal=Quant Imaging Med Surg |volume=8 |issue=8 |pages=853–875 |date=September 2018 |pmid=30306064 |pmc=6177362 |doi=10.21037/qims.2018.09.13 |url=}}</ref><ref name="pmid14747454">{{cite journal |vauthors=Hamilton D, Harris MD, Foweraker J, Gresham GA |title=Waterhouse-Friderichsen syndrome as a result of non-meningococcal infection |journal=J. Clin. Pathol. |volume=57 |issue=2 |pages=208–9 |date=February 2004 |pmid=14747454 |pmc=1770213 |doi= |url=}}</ref><ref name="pmid28828107">{{cite journal |vauthors=Di Serafino M, Severino R, Coppola V, Gioioso M, Rocca R, Lisanti F, Scarano E |title=Nontraumatic adrenal hemorrhage: the adrenal stress |journal=Radiol Case Rep |volume=12 |issue=3 |pages=483–487 |date=September 2017 |pmid=28828107 |pmc=5551907 |doi=10.1016/j.radcr.2017.03.020 |url=}}</ref><ref name="pmid29770310">{{cite journal |vauthors=Ierardi AM, Petrillo M, Patella F, Biondetti P, Fumarola EM, Angileri SA, Pesapane F, Pinto A, Dionigi G, Carrafiello G |title=Interventional radiology of the adrenal glands: current status |journal=Gland Surg |volume=7 |issue=2 |pages=147–165 |date=April 2018 |pmid=29770310 |pmc=5938278 |doi=10.21037/gs.2018.01.04 |url=}}</ref>
|[[Intussusception]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
|<nowiki>+</nowiki>
* N/A
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/- </nowiki>
|<nowiki>+</nowiki>
|
|
* [[Ultrasound]] is the [[Gold standard (test)|gold standard]] imaging modality used to diagnose intussusception<ref name="pmid17308922">{{cite journal |vauthors=Ko HS, Schenk JP, Tröger J, Rohrschneider WK |title=Current radiological management of intussusception in children |journal=Eur Radiol |volume=17 |issue=9 |pages=2411–21 |year=2007 |pmid=17308922 |doi=10.1007/s00330-007-0589-y |url=}}</ref>
* [[Flank]]/back [[pain]]
**Target or doughnut sign<ref name="pmid8470658">{{cite journal |vauthors=Boyle MJ, Arkell LJ, Williams JT |title=Ultrasonic diagnosis of adult intussusception |journal=Am. J. Gastroenterol. |volume=88 |issue=4 |pages=617–8 |year=1993 |pmid=8470658 |doi= |url=}}</ref>
* [[Weakness]]
***Edematous intussuscipien forms an external ring around the centrally located intussusceptum
* [[Hypovolemic shock]]
***Target sign is usually seen in right lower quadrant
* [[Adrenal crisis]] (massive [[hemorrhage]])
**Layers of intussusception forms pseudo-kidney appearance on the transverse view
* [[Adrenal insufficiency]]
* [[Symptoms]] of underlying [[cause]]
|
|
* [[Computed tomography|CT scan]] may be helpful in the [[diagnosis]] of intussusception. [[Computed tomography|CT scan]] maybe used when other image modalities like [[x-ray]] and [[ultrasound]] have not given positive results but suspicion of intussusception is high.
* [[Hypotension]]
* [[Abdominal]]/[[flank]] [[mass]]
* [[Hypovolemic shock]]
* [[Adrenal crisis]] (massive [[hemorrhage]])
* [[Adrenal insufficiency]]  
* [[Signs]] of underlying cause
|
|
* Intussusception occurs if there is an imbalance between the longitudinal and radial [[smooth muscle]] forces of [[intestine]] that maintain its normal structure. This imbalance leads to a segment of [[intestine]] to invaginate into another segment and cause entero-enteral intussusception. [[Etiology]] of intussusception is either idiopathic or [[Pathology|pathologic]] (lead point). 
* [[Anemia]]
* ↓ [[Serum]] and [[urinary]] [[Adrenal Gland|adrenal hormones]] and [[metabolites]]
* Findings related to underlying cause
|
|
* [[Pseudocyst]]: lined by [[fibrous tissue]]
* Findings related to underlying cause
|
* [[Adrenal]] [[ultrasound]]
* [[ACTH]] stimulation test
* Tests related to underlying cause
|
* Variable
|
* High density (acute [[hemorrhage]])
|
* N/A
|
* Isointense and low signal (Early [[hemorrhage]])
* Hypointense (Late [[hemorrhage]])
|
* Majority of the cases in [[neonantal]] peiod
* Majority of the cases caused by [[trauma]]
|-
|-
|8.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemangioma]]<br><ref name="pmid30306064">{{cite journal |vauthors=Wang F, Liu J, Zhang R, Bai Y, Li C, Li B, Liu H, Zhang T |title=CT and MRI of adrenal gland pathologies |journal=Quant Imaging Med Surg |volume=8 |issue=8 |pages=853–875 |date=September 2018 |pmid=30306064 |pmc=6177362 |doi=10.21037/qims.2018.09.13 |url=}}</ref><ref name="pmid22701011">{{cite journal |vauthors=Alhajri K, Alhasan I, Alzerwi N, Abudaff N |title=Adrenal haemangioma |journal=BMJ Case Rep |volume=2011 |issue= |pages= |date=April 2011 |pmid=22701011 |pmc=3079485 |doi=10.1136/bcr.12.2010.3604 |url=}}</ref><ref name="pmid29560018">{{cite journal |vauthors=Iwamoto G, Shimokihara K, Kawahara T, Takamoto D, Yao M, Teranishi JI, Otani M, Uemura H |title=Adrenal Hemangioma: A Case of Retroperitoneal Tumor |journal=Case Rep Med |volume=2018 |issue= |pages=8796327 |date=2018 |pmid=29560018 |pmc=5836307 |doi=10.1155/2018/8796327 |url=}}</ref><ref name="pmid26600897">{{cite journal |vauthors=Tarchouli M, Boudhas A, Ratbi MB, Essarghini M, Njoumi N, Sair K, Zentar A |title=Giant adrenal hemangioma: Unusual cause of huge abdominal mass |journal=Can Urol Assoc J |volume=9 |issue=11-12 |pages=E834–6 |date=2015 |pmid=26600897 |pmc=4639440 |doi=10.5489/cuaj.2967 |url=}}</ref>
|[[Hydronephrosis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
|<nowiki>+</nowiki>
* [[Cortisol]] (rare)
|<nowiki>+/-</nowiki>
* [[Aldosterone]] (rare)
|<nowiki>-</nowiki>
* [[Androgens]] (rare)
|<nowiki>-</nowiki>
|
|<nowiki>+ (CVA tenderness in case of pyelonephritis)</nowiki>
* [[Abdominal]] [[mass]] & discomfort
* [[Nausea]] & [[vomiting]]
* Back [[pain]]
* [[Hypovolemic shock]] ([[hemorrhage]])
* [[Symptoms]] of [[hormonal]] excess (very rare)
|
* [[Abdominal]] [[mass]]
* [[Hypovolemic shock]] ([[hemorrhage]])
* [[Symptoms]] of [[hormonal]] excess (very rare)
|
* N/L
* [[Anemia]] ([[hemorrhage]])
* ↑ [[Serum]] and [[urinary]] [[Adrenal gland|adrenal hormones]] and [[metabolites]] (very rare)
|
* [[Histopathology]] is gold standard
* Most often [[cavernous]]
* Peripheral dilated [[vascular]] spaces
* Monostromatic [[endothelium]]
* Absence of [[atypia]]
* Central [[necrosis]]
* [[Calcification]]
* [[Hemorrhage]]
|
* Complete [[endocrine]] panel
* [[Ultrasound]]
* [[FDG]]-[[PET]] scan
* [[Endoscopic ultrasound]]
* Post-[[resection]] [[biopsy]] (if [[malignancy]] is suspected)
|
|
* [[Ultrasound]] allows for visualization of the [[ureters]] and [[kidneys]] and can be used to assess the presence of [[hydronephrosis]] and/or [[hydroureter]]. 
* [[Calcification]]
* [[Phleboliths]]
|
|
* In the case of [[renal colic]] (one sided loin pain usually accompanied by a trace of blood in the urine) the initial investigation is usually an intravenous urogram. This has the advantage of showing whether there is any obstruction of flow of urine causing [[hydronephrosis]] as well as demonstrating the function of the other kidney. Many [[Stones- kidney|stones]] are not visible on [[X ray|plain x ray]] or IVU but 99% of [[Stones- kidney|stones]] are visible on [[CT]] and therefore CT is becoming a common choice of initial investigation.
* [[Calcification]]
* [[Phleboliths]]
* Irregular peripheral enhancement
|
|
* The kidney undergoes extensive dilation with atrophy and thinning of the renal cortex.
* N/A
|
|
* Hyperintensity (T2) hypointensity (T1)
* Peripheral spotty and centripetal enhancement
|
* Majority of the cases diagnosed incidentally
* Majority of the [[lesions]] are non-functional with [[female]] pre-dominance
|-
|-
|9.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lymphoma]]<br><ref name="pmid30306064">{{cite journal |vauthors=Wang F, Liu J, Zhang R, Bai Y, Li C, Li B, Liu H, Zhang T |title=CT and MRI of adrenal gland pathologies |journal=Quant Imaging Med Surg |volume=8 |issue=8 |pages=853–875 |date=September 2018 |pmid=30306064 |pmc=6177362 |doi=10.21037/qims.2018.09.13 |url=}}</ref><ref name="pmid28794358">{{cite journal |vauthors=Harada K, Kimura K, Iwamuro M, Terasaka T, Hanayama Y, Kondo E, Hayashi E, Yoshino T, Otsuka F |title=The Clinical and Hormonal Characteristics of Primary Adrenal Lymphomas: The Necessity of Early Detection of Adrenal Insufficiency |journal=Intern. Med. |volume=56 |issue=17 |pages=2261–2269 |date=September 2017 |pmid=28794358 |pmc=5635296 |doi=10.2169/internalmedicine.8216-16 |url=}}</ref><ref name="pmid27795295">{{cite journal |vauthors=Laurent C, Casasnovas O, Martin L, Chauchet A, Ghesquieres H, Aussedat G, Fornecker LM, Bologna S, Borot S, Laurent K, Bouillet B, Verges B, Petit JM |title=Adrenal lymphoma: presentation, management and prognosis |journal=QJM |volume=110 |issue=2 |pages=103–109 |date=February 2017 |pmid=27795295 |doi=10.1093/qjmed/hcw174 |url=}}</ref><ref name="pmid29344029">{{cite journal |vauthors=Karimi F |title=Primary Adrenal Lymphoma Presenting with Adrenal Failure: A Case Report and Review of the Literature |journal=Int J Endocrinol Metab |volume=15 |issue=4 |pages=e12014 |date=October 2017 |pmid=29344029 |pmc=5750783 |doi=10.5812/ijem.12014 |url=}}</ref>
|[[Dysplasia|Dysplastic kidney]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
|N/A
* N/A
|N/A
|
|N/A
* [[Fatigue]]
|N/A
* Loss of [[appetite]]
|N/A
* [[Weight loss]]
* [[Pigmentation]] of [[skin]]
* [[Flank]]/[[abdominal]] [[pain]]
* [[Fever]]
* [[Nausea]] & [[vomiting]]
|
* [[Hypotension]]
* [[Altered mental status]]
* [[Abdominal]]/[[flank]] [[mass]]
* [[Fever]]
* [[Weight loss]]
|
* ↑ [[ESR]]
* ↑ [[LDH]]
* ↑ [[Serum]] [[ACTH]]
* ↓ [[Hyponatremia]]
* Low early morning [[serum]] [[cortisol]] levels
* Low basal [[urinary]] [[cortisol]]
* ↓ [[Aldosterone]]
|
* [[Histopathology]] is gold standard
* Diffuse growth pattern with large [[cells]] ( 5× normal [[lymphocytes]]) resembling [[immunoblasts]]
* Extensive [[necrosis]]
* May resemble [[anaplastic]] large [[cell]] [[lymphoma]] or [[metastatic]] [[carcinoma]]
* Abundant [[T-cells]]
|
|
MCDK is usually diagnosed by [[ultrasound]] examination before birth.
* Complete [[endocrine]] panel
* Mass of non-communicating cysts of variable size.
* [[Ultrasound]]
* Unlike severe [[hydronephrosis]], in which the largest cystic structure (the renal pelvis) lies in a central location and is surrounded by dilated calices, in multicystic dysplastic kidney the cyst distribution shows no recognizable pattern.
* [[ACTH]] stimulation test
* [[Dysplasia|Dysplastic]], echogenic [[parenchyma]] may be visible between the cysts, but no normal renal parenchyma is seen.
* [[CT]]-guided needle [[biopsy]]
* <sup>18</sup>F-fluorodeoxyglucose ([[FDG]]) [[positron emission tomography]] [[PET]]/[[CT]]
|
|
* MCKD can be discovered accidentally on [[CT]] scan.
* Heterogeneous [[mass]]  
* [[CT scan]] shows myltiple cysts with absence of renal parenchyma.
* [[Hemorrhages]]
|
|
* MCKD is the result of abnormal differentiation of the renal parenchyma.
* Heterogeneous [[mass]]
* [[Hemorrhages]]
* [[Necrosis]]
|
|
* N/A
|
* Enlarged [[retroperitoneal]] [[lymph nodes]]
* Low intensity (T1)
* High intensity (T2)
|
* May stain positive for:
** [[CD3]], [[CD19]], [[CD20]], [[CD22]]
** [[BCL6]] / [[CD10]]
** [[CD43]], [[CD45]]
** [[Immunoglobulin A|Surface Ig]]
** [[CD68]]
** [[CD79a]]
** [[LCA]]
** [[Pax genes|Pax 5]]
|-
|-
|10.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cystic Lymphangioma]]<br><ref name="pmid30306064">{{cite journal |vauthors=Wang F, Liu J, Zhang R, Bai Y, Li C, Li B, Liu H, Zhang T |title=CT and MRI of adrenal gland pathologies |journal=Quant Imaging Med Surg |volume=8 |issue=8 |pages=853–875 |date=September 2018 |pmid=30306064 |pmc=6177362 |doi=10.21037/qims.2018.09.13 |url=}}</ref><ref name="pmid27011561">{{cite journal |vauthors=Michalopoulos N, Laskou S, Karayannopoulou G, Pavlidis L, Kanellos I |title=Adrenal Gland Lymphangiomas |journal=Indian J Surg |volume=77 |issue=Suppl 3 |pages=1334–42 |date=December 2015 |pmid=27011561 |pmc=4775622 |doi=10.1007/s12262-015-1206-y |url=}}</ref><ref name="pmid25197378">{{cite journal |vauthors=Zhao M, Gu Q, Li C, Yu J, Qi H |title=Cystic lymphangioma of adrenal gland: a clinicopathological study of 3 cases and review of literature |journal=Int J Clin Exp Pathol |volume=7 |issue=8 |pages=5051–6 |date=2014 |pmid=25197378 |pmc=4152068 |doi= |url=}}</ref><ref name="pmid25889625">{{cite journal |vauthors=Joliat GR, Melloul E, Djafarrian R, Schmidt S, Fontanella S, Yan P, Demartines N, Halkic N |title=Cystic lymphangioma of the adrenal gland: report of a case and review of the literature |journal=World J Surg Oncol |volume=13 |issue= |pages=58 |date=February 2015 |pmid=25889625 |pmc=4335415 |doi=10.1186/s12957-015-0490-0 |url=}}</ref>
|[[Neuroblastoma|Pediatric Neuroblastoma]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
|<nowiki>+</nowiki>
* N/A
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
* Asymptomatic
|<nowiki>+/-</nowiki>
* [[Flank]]/back/[[abdominal]] [[pain]]
|<nowiki>+/-</nowiki>
* [[Abdominal]]/[[flank]] [[mass]]
* [[GI]] obstruction
|
* N/L
* Palpable [[mass]]
* [[Hypertension]]
* [[Fever]]
|
* N/L
|
|
* On ultrasound, neuroblastoma is characterized by a heterogeneous [[echogenicity]] due to the [[vascular]], [[necrotic]], and calcified content of the mass.<ref name="radio">Neuroblastoma. Radiopaedia (2015) http://radiopaedia.org/articles/neuroblastoma Accessed on October, 8 2015</ref>
* [[Histopathology]] is gold standard
* Cystic channels and spaces
* Flat [[endothelial cells]]
* Mature [[lymphoid]] aggregates
|
|
*CT scan is the investigation of choice for the diagnosis of neuroblastoma.<ref name="pmid21736987">{{cite journal| author=Colon NC, Chung DH| title=Neuroblastoma. | journal=Adv Pediatr | year= 2011 | volume= 58 | issue= 1 | pages= 297-311 | pmid=21736987 | doi=10.1016/j.yapd.2011.03.011 | pmc=PMC3668791 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21736987  }}</ref>
* Complete [[endocrine]] panel
*On CT scan, neuroblastoma is characterized by:<ref name="radio2">Neuroblastoma. Radiopaedia (2015) http://radiopaedia.org/articles/neuroblastoma Accessed on October, 8 2015</ref>
* [[Ultrasound]]
:*Heterogeneous mass
* [[FDG]]-[[PET]] scan
:*[[Calcification]]
* [[Aspiration]] & [[biopsy]]
:*[[Necrosis]]
:*Compression of the surrounding vessels
:*Invasion of the [[psoas]] [[muscle]] or [[kidney]]s
:*Swollen [[lymph node]]s
|
|
*On microscopic histopathological analysis the presence of round blue cells separated by thin [[fibrous]] septa are characteristic findings of neuroblastoma.
* Well-demarcated
*Other findings of neuroblastoma on [[light microscopy]] may include:<ref name="patho">Neuroblastoma. Libre Pathology(2015) http://librepathology.org/wiki/index.php/Adrenal_gland#Neuroblastoma Accessed on October, 5 2015</ref>
* [[Calcification]]
:*Homer-Wright rosettes (rosettes with a small  meshwork of fibers at the center)
:*Neuropil-like [[stroma]] (paucicellular stroma with a cotton candy-like appearance)
*On [[electron microscopy]] neuroblastoma is characterized by:
:*Dendritic processes with longitudinally oriented [[microtubule]]s
:*Membrane bound electron-dense [[granule]]s that contain [[catecholamine]]s
:*Presence of [[desmosomes]]
:*Absence of [[glycogen]]
|
|
* Well-demarcated
* Low-density
* [[Calcification]]
|
* N/A
|
* T1 hypointense & T2 hyperintense
|
* Associated with [[Gorlin-Goltz syndrome]]
* Stains positive for [[CD31]], [[CD34]], and D2-40 and negative for [[cytokeratin]]
|-
|-
|11.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Teratoma]]<br><ref name="pmid30306064">{{cite journal |vauthors=Wang F, Liu J, Zhang R, Bai Y, Li C, Li B, Liu H, Zhang T |title=CT and MRI of adrenal gland pathologies |journal=Quant Imaging Med Surg |volume=8 |issue=8 |pages=853–875 |date=September 2018 |pmid=30306064 |pmc=6177362 |doi=10.21037/qims.2018.09.13 |url=}}</ref><ref name="pmid29067922">{{cite journal |vauthors=Ramakant P, Rana C, Singh KR, Mishra A |title=Primary adrenal teratoma: An unusual tumor - Challenges in diagnosis and surgical management |journal=J Postgrad Med |volume=64 |issue=2 |pages=112–114 |date=2018 |pmid=29067922 |pmc=5954807 |doi=10.4103/jpgm.JPGM_588_16 |url=}}</ref><ref name="pmid26722254">{{cite journal |vauthors=Li S, Li H, Ji Z, Yan W, Zhang Y |title=Primary adrenal teratoma: Clinical characteristics and retroperitoneal laparoscopic resection in five adults |journal=Oncol Lett |volume=10 |issue=5 |pages=2865–2870 |date=November 2015 |pmid=26722254 |pmc=4665718 |doi=10.3892/ol.2015.3701 |url=}}</ref><ref name="pmid30214733">{{cite journal |vauthors=Zhou L, Pan X, He T, Lai Y, Li W, Hu Y, Ni L, Yang S, Chen Y, Lai Y |title=Primary adrenal teratoma: A case series and review of the literature |journal=Mol Clin Oncol |volume=9 |issue=4 |pages=437–442 |date=October 2018 |pmid=30214733 |pmc=6125700 |doi=10.3892/mco.2018.1687 |url=}}</ref>
|[[Rhabdomyosarcoma|Pediatric Rhabdomyosarcoma]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
|<nowiki>+</nowiki>
* N/A
|<nowiki>+/-</nowiki>
|
|<nowiki>+/-</nowiki>
* Asymptomatic
|<nowiki>-</nowiki>
* [[Abdominal]]/back discomfort & [[pain]]
|<nowiki>+/-</nowiki>
* [[Abdominal]] distension
* [[Lumbago]]
* [[Nausea]] & [[vomiting]]
* Local obstructive [[symptoms]]
|
* N/L
* [[Abdominal]] distension
* [[Abdominal]] [[mass]]
* [[Weight loss]]
* [[Urinary]] retention
* Lower extremity [[edema]]
* [[Peritoneal]] [[effusion]] or [[peritonitis]] (rupture)
|
* N/L
|
* [[Fibrous tissue]], [[adipose tissue]] and [[muscle fibers]]
* [[Stratified squamous epithelium]], [[hair]] shafts, [[fat cells]], [[GI]] and [[respiratory]] [[epithelium]]
* [[Necrosis]]
* [[Calcification]]
|
* Complete [[endocrine]] panel
* <sup>18</sup>F-fluorodeoxyglucose ([[FDG]]) [[positron emission tomography]] [[PET]]/[[CT]]
* Post-resection [[biopsy]] (if [[malignancy]] is suspected)
|
* Heterogeneous
* Mixed echo ([[Ultrasonogram|U/S]])
|
* Heterogeneous
* Mixed density elements
* Egg-shell [[calcification]]
* Mild enhancement
|
|
|On [[CT scan]], rhabdomyosarocma is characterized by:
* N/A
* Soft tissue density
* Some enhancement with [[contrast]]
* Adjacent bony destruction (over 20% of cases)
|
|
* Rhadbomyosarcoma has an appearance similar to the other round blue cell tumors such as [[Ewing sarcoma]] and [[Osteoblastoma|small cell osteoblastoma]].
* Mild enhancement
* Mixed signals ([[MRI]])
|
|
* Derived from [[germ layers]]
* Majority are [[benign]], but about one forth of [[adrenal]] [[teratoma]] are [[malignant]] [[lesions]]
|-
|-
|12.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Metastases]]<br><ref name="pmid30306064">{{cite journal |vauthors=Wang F, Liu J, Zhang R, Bai Y, Li C, Li B, Liu H, Zhang T |title=CT and MRI of adrenal gland pathologies |journal=Quant Imaging Med Surg |volume=8 |issue=8 |pages=853–875 |date=September 2018 |pmid=30306064 |pmc=6177362 |doi=10.21037/qims.2018.09.13 |url=}}</ref><ref name="pmid15541184">{{cite journal |vauthors=Karanikiotis C, Tentes AA, Markakidis S, Vafiadis K |title=Large bilateral adrenal metastases in non-small cell lung cancer |journal=World J Surg Oncol |volume=2 |issue= |pages=37 |date=November 2004 |pmid=15541184 |pmc=535544 |doi=10.1186/1477-7819-2-37 |url=}}</ref><ref name="pmid15405683">{{cite journal |vauthors=ABRAMS HL, SPIRO R, GOLDSTEIN N |title=Metastases in carcinoma; analysis of 1000 autopsied cases |journal=Cancer |volume=3 |issue=1 |pages=74–85 |date=January 1950 |pmid=15405683 |doi= |url=}}</ref><ref name="pmid15554272">{{cite journal |vauthors=Gerber E, Dinlenc C, Wagner JR |title=Laparoscopic adrenalectomy for isolated adrenal metastasis |journal=JSLS |volume=8 |issue=4 |pages=314–9 |date=2004 |pmid=15554272 |pmc=3016821 |doi= |url=}}</ref><ref name="pmid9781426">{{cite journal |vauthors=Vaughan ED |title=Diagnosis and management of surgical adrenal disorders |journal=Int. J. Urol. |volume=5 |issue=5 |pages=401–17 |date=September 1998 |pmid=9781426 |doi= |url=}}</ref>
|[[Mesoblastic nephroma]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
|<nowiki>+</nowiki>
* Related to the primary [[tumor]]
|<nowiki>+</nowiki>
|
|<nowiki>-</nowiki>
* Asymptomatic
|<nowiki>+</nowiki>
* [[Adrenal insufficiency]]
|<nowiki>-</nowiki>
* [[Abdominal]] [[mass]] & discomfort
* [[Symptoms]] due to primary [[tumor]] that may include:
** [[Lung cancer]]
** [[Breast cancer]]
** [[Gastric cancer]]
** [[Liver cancer]]
** [[Pancreatic cancer]]
** [[Renal cell carcinoma]]
** [[Melanoma]]
** [[Lymphoma]]
|
* Asymptomatic
* [[Adrenal insufficiency]]
* [[Abdominal]] [[mass]]
* [[Signs]] due to primary [[tumor]] that may include
** [[Lung cancer]]
** [[Breast cancer]]
** [[Gastric cancer]]
** [[Liver cancer]]
** [[Pancreatic cancer]]
** [[Renal cell carcinoma]]
** [[Melanoma]]
** [[Lymphoma]]
|
* Varies depending on the primary [[tumor]]
* N/L
* If [[adrenal insufficiency]]:
** [[Hyponatremia]]
** [[Hyperkalemia]]
** [[Hypoglycemia]]
** Low early morning [[serum]] [[cortisol]] levels
** Low basal [[urinary]] [[cortisol]]
** ↑ [[ACTH]]
** ↓ [[Aldosterone]]
** ↑ [[Plasma]] [[renin]]
|
* Single or multiple firm [[masses]]
* [[Hemorrhage]]
* [[Necrosis]]
 
* [[Morphology]] similar to the primary [[tumor]]
* Compression and [[atrophy]] of adjacent [[adrenal]] [[tissue]]
|
|
*[[Ultrasound]] may be helpful in the diagnosis of mesoblastic nephroma.
* [[Blood]] and [[urine]] lab testing
*Mesoblastic nephroma may presents as a well-defined [[mass]] with low-level homogeneous echoes.<ref name="radio3">Mesoblastic nephroma.Dr Ayush Goel and Dr Yuranga Weerakkody et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/mesoblastic-nephroma</ref>
* Complete [[endocrine]] panel
*The presence of concentric echogenic and hypoechoic rings can be a helpful diagnostic feature of [[mesoblastic nephroma]].
* [[Imaging]] of [[chest]], [[abdomen]], and [[pelvis]]
* [[Immunohistochemistry]]
* [[Endoscopy]]
* [[MRCP]] & [[ERCP]]
* <sup>18</sup>F-fluorodeoxyglucose ([[FDG]]) [[positron emission tomography]] [[PET]]/[[CT]]
|
|
* [[CT scan]] may be helpful in the diagnosis of mesoblastic nephroma.
* [[Calcification]]
* Findings on CT scan suggestive of mesoblastic nephroma include:
* [[Hemorrhage]]
:* Solid hypoattenuating renal lesion
:* Variable contrast enhancement
:* No [[calcification]]
|
|
Classic mesoblastic nephroma
* [[Calcification]]
* [[Spindle cells]] in [[fascicles]]
* [[Hemorrhage]]
* Infiltrative border
* Irregular peripheral enhancement
Cellular mesoblastic nephroma
|
* Plump cells with vesicular nuclei
* N/A
* Well-defined border
|
* Mitotically active
* Low signal on T1-weighed [[MRI]] and high signal on T2-weighed [[MRI]]
Mixed mesoblastic nephroma
OR
* Both classic pattern and cellular pattern areas are present
* Isointense on T1- and T2-weighed [[MRI]]
|Most common renal tumor that occurs in 1st month of life
|
* [[Metastases]] more common than primary [[adrenal tumors]]
* [[Adrenal]] [[hemorrhage]] is the most serious [[complication]] and may present as [[adrenal crisis]] and/or [[shock]]
|}
|}
==References==
{{reflist|2}}


==References==
==References==

Latest revision as of 20:10, 5 March 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD[2]Haytham Allaham, M.D. [3]

Overview

Intra-abdominal neuroblastoma must be differentiated from other diseases that cause abdominal distension and constipation such as Wilms tumor and ganglioneuroma. Intra-thoracic neuroblastoma must be differentiated from other diseases that cause shortness of breath and chronic cough such as intrathoracic lymphoma and extra lobar pulmonary sequestration.

Differentiationg Neuroblastoma from other Diseases

Abbreviations

ACTH: Adrenocorticotropic hormone, ARR: Aldosterone-renin ratio, CAM: Cellular adhesion molecules, ERCP: Endoscopic retrograde cholangiopancreatography, ESR: Erythrocyte sedimentation rate, CT: Computerized tomography, Fluorescence in situ hybridization, FDG: Fluorodeoxyglucose, FSH: Follicle stimulating hormone, GI: Gastrointestinal, H&E stain: Hematoxylin and eosin stain, LCA: Leukocyte common antigen, LDH: Lactate dehydrogenase, LH: Luteinizing hormone, MEN: Multiple endocrine neoplasia, MRCP: Magnetic resonance cholangiopancreatography, MRI: Magnetic resonance imaging, N/A: Not applicable/Not available, N/L: Normal, PAS stain: Periodic acid–Schiff stain, PET: Position emission tomography, PGP: Protein gene product 9.5, TB: Tuberculosis, U/S: Ultrasound, ZF: Zona fasciculata, ZG: Zona granulosa, ZR: Zona reticularis.

Adrenal Cortex Product Clinical manifestations Diagnosis Other features
Symptoms Signs Blood & Urine Histopathological Others Ultrasound CT scan FDG PET/CT MRI
Adrenal Adenoma Aldosterone
[1][2][3][4]
  • Iso and low FDG uptake compared with liver
  • Hyperintense on in-phase and hypointense on oppose-phase
Cortisol
[1][5][6][7]
  • Iso and low FDG uptake compared with liver
  • Hyperintense on in-phase and hypointense on oppose-phase
Androgens
[4][8][9][10]
  • Well-defined
  • Solid mass
  • N/A
  • Hyperintense on in-phase and hypointense on oppose-phase
Non-functional
[1][11][12][13]
  • Solid, well defined mass
  • High lipid content and adjacent compression
  • N/A
  • Hyperintense on in-phase and hypointense on oppose-phase
Adrenal Carcinoma
[12][14][15][16][17]
  • N/A
  • Heterogeneous enhancement
  • Heterogeneous mass with intense FDG uptake greater than liver
  • Heterogenous hyper-intensity (T2-weighted) and hypo-intensity on (T1-weighted)
Adrenal Hyperplasia
[2][5][4][8][9][15][18][19]
  • N/A
  • Unilateral or bilateral adrenal enlargement or thickening
  • Signaling is same as that of normal adrenal gland
Medulla Product Clinical manifestations Diagnosis Other features
Symptoms Signs Blood & Urine Histopathological Others Ultrasound CT scan FDG PET/CT MRI
Pheochromocytoma
[20][21][22][23][24]
  • N/A
Neuroblastoma
[15][25][26][27]
  • Large mass
  • May cross midline
  • N/A
 Stains positive for:
Ganglioneuroma
[15][28][29][30]
  • N/A
  • N/A
  • Hypointense (T1-weighted)
  • Varied signal (T2-weighted)

Stains positive for:

Stroma Product Clinical manifestations Diagnosis Other features
Symptoms Signs Blood & Urine Histopathological Others Ultrasound CT scan FDG PET/CT MRI
Lipoma/Myolipoma
[15][31][32][33]
  • N/A
  • N/L
  • N/A
  • High signal
Others Product Clinical manifestations Diagnosis Other features
Symptoms Signs Blood & Urine Histopathological Others Ultrasound CT scan FDG PET/CT MRI
Tuberculosis
[34][35][36][37][38]
  • N/A
  • Variable
Histoplasmosis
[39][40][41][42][43]
  • N/A
Cysts
[15][44][45][46]
  • N/A
  • Gold standard
  • Circumscribed anechoic or hypoechoic mass
  • N/A
  • High signal
Hematoma
[15][47][48][49]
  • N/A
  • Variable
  • N/A
  • Majority of the cases in neonantal peiod
  • Majority of the cases caused by trauma
Hemangioma
[15][50][51][52]
  • N/A
  • Hyperintensity (T2) hypointensity (T1)
  • Peripheral spotty and centripetal enhancement
  • Majority of the cases diagnosed incidentally
  • Majority of the lesions are non-functional with female pre-dominance
Lymphoma
[15][53][54][55]
  • N/A
  • N/A
Cystic Lymphangioma
[15][56][57][58]
  • N/A
  • N/L
  • N/A
  • T1 hypointense & T2 hyperintense
Teratoma
[15][59][60][61]
  • N/A
  • N/L
  • Heterogeneous
  • Mixed echo (U/S)
  • Heterogeneous
  • Mixed density elements
  • Egg-shell calcification
  • Mild enhancement
  • N/A
  • Mild enhancement
  • Mixed signals (MRI)
Metastases
[15][62][63][64][65]
  • Related to the primary tumor
  • N/A
  • Low signal on T1-weighed MRI and high signal on T2-weighed MRI

OR

  • Isointense on T1- and T2-weighed MRI

References

  1. ↑ 1.0 1.1 1.2 Park JJ, Park BK, Kim CK (June 2016). "Adrenal imaging for adenoma characterization: imaging features, diagnostic accuracies and differential diagnoses". Br J Radiol. 89 (1062): 20151018. doi:10.1259/bjr.20151018. PMC 5258164. PMID 26867466.
  2. ↑ 2.0 2.1 Monticone S, Castellano I, Versace K, Lucatello B, Veglio F, Gomez-Sanchez CE, Williams TA, Mulatero P (August 2015). "Immunohistochemical, genetic and clinical characterization of sporadic aldosterone-producing adenomas". Mol. Cell. Endocrinol. 411: 146–54. doi:10.1016/j.mce.2015.04.022. PMC 4474471. PMID 25958045.
  3. ↑ Stowasser M, Taylor PJ, Pimenta E, Ahmed AH, Gordon RD (May 2010). "Laboratory investigation of primary aldosteronism". Clin Biochem Rev. 31 (2): 39–56. PMC 2874431. PMID 20498828.
  4. ↑ 4.0 4.1 4.2 Guerrisi A, Marin D, Baski M, Guerrisi P, Capozza F, Catalano C (2013). "Adrenal lesions: spectrum of imaging findings with emphasis on multi-detector computed tomography and magnetic resonance imaging". J Clin Imaging Sci. 3: 61. doi:10.4103/2156-7514.124088. PMC 3935261. PMID 24605256.
  5. ↑ 5.0 5.1 Stratakis CA (2008). "Cushing syndrome caused by adrenocortical tumors and hyperplasias (corticotropin- independent Cushing syndrome)". Endocr Dev. 13: 117–32. doi:10.1159/000134829. PMC 3132884. PMID 18493137.
  6. ↑ Zilbermint M, Stratakis CA (June 2015). "Protein kinase A defects and cortisol-producing adrenal tumors". Curr Opin Endocrinol Diabetes Obes. 22 (3): 157–62. doi:10.1097/MED.0000000000000149. PMC 4560837. PMID 25871963.
  7. ↑ Wei J, Li S, Liu Q, Zhu Y, Wu N, Tang Y, Li Q, Ren K, Zhang Q, Yu Y, An Z, Chen J, Li J (April 2018). "ACTH-independent Cushing's syndrome with bilateral cortisol-secreting adrenal adenomas: a case report and review of literatures". BMC Endocr Disord. 18 (1): 22. doi:10.1186/s12902-018-0250-6. PMC 5913873. PMID 29685132.
  8. ↑ 8.0 8.1 Arnold DT, Reed JB, Burt K (January 2003). "Evaluation and management of the incidental adrenal mass". Proc (Bayl Univ Med Cent). 16 (1): 7–12. PMC 1200803. PMID 16278716.
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References

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