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| __NOTOC__ | | __NOTOC__ |
| {{Adrenal carcinoma}} | | {{Adrenal carcinoma}} |
| {{CMG}};{{AE}}{{SM}} | | {{CMG}} |
| ==Pathophysiology== | | ==Pathophysiology== |
| ===Genetics===
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| The main etiologic factor of adrenocortical cancer is unknown. Families with [[Li-Fraumeni syndrome]] have increased risk. The [[p53]], [[retinoblastoma protein]] (RB) [[tumor suppressor gene]]s located on chromosomes 17p, 13q respectively, may be changed. The genes h19, insulin-like growth factor II ([[IGF-II]]), p57<sup>kip2</sup> are important for fetal growth and development. They are located on chromosome 11p. Expression of the h19 gene is markedly reduced in both nonfunctioning and functioning adrenal cortical carcinomas, especially in tumors producing [[cortisol]] and [[aldosterone]]. There is also a loss of activity of the p57<small>kip2</small> gene product in [[virilizing]] adenomas and adrenal cortical carcinomas. In contrast, IGF-II gene expression has been shown to be high in adrenal cortical carcinomas. Finally, c-myc gene expression is relatively high in neoplasms, and it is often linked to poor prognosis.<ref>{{cite book |author=Kufe D |editor=Benedict RC, Holland JF |title=Cancer medicine |publisher=B.C. Decker |location=Hamilton, Ont |year=2000 |edition=5th |isbn=1-55009-113-1 |oclc=156944448 }}</ref>
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| ===Pathology=== | | ===Pathology=== |
| Adrenal tumors are often not biopsied prior to surgery, so diagnosis is confirmed on examination of the surgical specimen by a [[anatomical pathology|pathologist]]. Grossly, adrenocortical carcinomas are often large, with a tan-yellow cut surface, and areas of [[hemorrhage]] and [[necrosis]]. On [[histopathology|microscopic examination]], the tumor usually displays sheets of atypical cells with some resemblance to the cells of the normal [[adrenal cortex]]. The presence of [[invasion]] and [[mitosis|mitotic activity]] help differentiate small cancers from [[adrenocortical adenoma]]s.<ref name="Weidner's">{{cite book |author=Richard Cote, Saul Suster, Lawrence Weiss, Noel Weidner (Editor) |title=Modern Surgical Pathology (2 Volume Set) |publisher=W B Saunders |location=London |year= |pages= |isbn=0-7216-7253-1 |oclc= |doi=}}</ref>There are several relatively rare variants of adrenal cortical carcinoma: Oncocytic adrenal cortical carcinoma, Myxoid adrenal cortical carcinoma, Carcinosarcoma, Adenosquamous adrenocortical carcinoma, Clear cell adrenal cortical carcinoma. | | Adrenal tumors are often not biopsied prior to surgery, so diagnosis is confirmed on examination of the surgical specimen by a [[anatomical pathology|pathologist]]. |
| ====Gross Pathology====
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| Shown below is the gross appearance of adrenocortical carcinoma.This large adrenal cortical carcinoma was resected from a 27-year-old female. The tumor measured 17 cm in diameter and invaded kidney and spleen which necessitated en bloc removal of these organs with tumor. Patient had evidence of virilization.
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| [[Image:Adrenal_cortical_carcinoma.JPG|400px]]
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| ====Microscopy====
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| Shown below is a micrograph of an adrenocortical carcinoma (left of image - dark blue) and the adrenal cortex it arose from (right-top of image - pink/light blue). Benign adrenal medulla is present (right-middle of image - gray/blue). H&E stain.
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| [[Image: 800px-Adrenal_cortical_carcinoma_-_low_mag.jpg|400px]]
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| =====Video=====
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| Shown below is a video explaining the histology of adrenocortical carcinoma
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| {{#ev:youtube|7jMFENhPaOM}}
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| ==References== | | ==References== |
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| [[Category:Disease]] | | [[Category:Disease]] |
| [[Category:Endocrinology]] | | [[Category:Endocrinology]] |
| [[Category:Oncology]]
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| [[Category:Needs Overview]] | | [[Category:Needs Overview]] |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
| | [[Category:Up-To-Date]] |
| | [[Category:Oncology]] |
| | [[Category:Medicine]] |
| | [[Category:Endocrinology]] |
| | [[Category:Surgery]] |