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Large Degenerated Adrenal Adenomas: Radiologic-Pathologic Correlation

¹ Departments of Radiology (J.H.N., B.J.W., T.J.I., A.J.D.)
² Endocrine Pathology (C.S.H., C.F.A.), Armed Forces Institute of Pathology, Department of Radiologic Pathology, Washington, DC.

View larger version (123K): [in a new window]   Figure 1a. Adrenal adenoma in a 73-year-old woman with a palpable mass. (a) Contrast-enhanced CT scan shows a large, heterogeneous mass with a large, central region of low attenuation (*), calcifications (arrowheads), and irregular peripheral enhancement (arrows). (b) Cut section of gross specimen shows regions of hemorrhagic necrosis (*); only the small yellow regions are viable adenoma.

View larger version (115K): [in a new window]   Figure 1b. Adrenal adenoma in a 73-year-old woman with a palpable mass. (a) Contrast-enhanced CT scan shows a large, heterogeneous mass with a large, central region of low attenuation (*), calcifications (arrowheads), and irregular peripheral enhancement (arrows). (b) Cut section of gross specimen shows regions of hemorrhagic necrosis (*); only the small yellow regions are viable adenoma.

View larger version (154K): [in a new window]   Figure 2a. Adrenal adenoma with infarction discovered incidentally at CT in a 64-year-old woman. (a) Contrast-enhanced CT scan shows a low-attenuation mass with an enhancing wall (arrows) and peripheral nodules (arrowheads). (b) Cut section of gross specimen shows hemorrhagic necrosis (*); only the small yellow regions at the periphery of the mass are adenoma tissue.

View larger version (150K): [in a new window]   Figure 2b. Adrenal adenoma with infarction discovered incidentally at CT in a 64-year-old woman. (a) Contrast-enhanced CT scan shows a low-attenuation mass with an enhancing wall (arrows) and peripheral nodules (arrowheads). (b) Cut section of gross specimen shows hemorrhagic necrosis (*); only the small yellow regions at the periphery of the mass are adenoma tissue.

View larger version (149K): [in a new window]   Figure 3a. Adrenal adenoma discovered incidentally at ultrasonography in an 81-year-old man. (a) Contrast-enhanced CT scan shows peripheral enhancement (arrow) and a central region of irregular low attenuation (*). The tiny area of high attenuation in the anterior of the mass is an artifact. (b) Cut section of gross specimen shows hemorrhagic necrosis (*); the only viable adenoma is represented by the irregular yellow regions.

View larger version (139K): [in a new window]   Figure 3b. Adrenal adenoma discovered incidentally at ultrasonography in an 81-year-old man. (a) Contrast-enhanced CT scan shows peripheral enhancement (arrow) and a central region of irregular low attenuation (*). The tiny area of high attenuation in the anterior of the mass is an artifact. (b) Cut section of gross specimen shows hemorrhagic necrosis (*); the only viable adenoma is represented by the irregular yellow regions.

View larger version (172K): [in a new window]   Figure 4a. Adrenal adenoma discovered incidentally in a 59-year-woman many years after the patient underwent right nephrectomy for multicystic dysplastic kidney. (a) Contrast-enhanced CT scan shows a low-attenuation mass (*) with focal calcifications (curved arrow) and enhancement (straight arrow). (b) Coronal T1-weighted MR image shows a low-signal-intensity mass (*) with minimal heterogeneity. (c) T2-weighted transverse MR image shows that the mass (*) has marked heterogeneity. (d) Cut section of gross specimen reveals regions of acute and chronic hemorrhage and necrosis (*); the yellow regions represent viable adenoma.

View larger version (180K): [in a new window]   Figure 4b. Adrenal adenoma discovered incidentally in a 59-year-woman many years after the patient underwent right nephrectomy for multicystic dysplastic kidney. (a) Contrast-enhanced CT scan shows a low-attenuation mass (*) with focal calcifications (curved arrow) and enhancement (straight arrow). (b) Coronal T1-weighted MR image shows a low-signal-intensity mass (*) with minimal heterogeneity. (c) T2-weighted transverse MR image shows that the mass (*) has marked heterogeneity. (d) Cut section of gross specimen reveals regions of acute and chronic hemorrhage and necrosis (*); the yellow regions represent viable adenoma.

View larger version (147K): [in a new window]   Figure 4c. Adrenal adenoma discovered incidentally in a 59-year-woman many years after the patient underwent right nephrectomy for multicystic dysplastic kidney. (a) Contrast-enhanced CT scan shows a low-attenuation mass (*) with focal calcifications (curved arrow) and enhancement (straight arrow). (b) Coronal T1-weighted MR image shows a low-signal-intensity mass (*) with minimal heterogeneity. (c) T2-weighted transverse MR image shows that the mass (*) has marked heterogeneity. (d) Cut section of gross specimen reveals regions of acute and chronic hemorrhage and necrosis (*); the yellow regions represent viable adenoma.

View larger version (131K): [in a new window]   Figure 4d. Adrenal adenoma discovered incidentally in a 59-year-woman many years after the patient underwent right nephrectomy for multicystic dysplastic kidney. (a) Contrast-enhanced CT scan shows a low-attenuation mass (*) with focal calcifications (curved arrow) and enhancement (straight arrow). (b) Coronal T1-weighted MR image shows a low-signal-intensity mass (*) with minimal heterogeneity. (c) T2-weighted transverse MR image shows that the mass (*) has marked heterogeneity. (d) Cut section of gross specimen reveals regions of acute and chronic hemorrhage and necrosis (*); the yellow regions represent viable adenoma.

View larger version (143K): [in a new window]   Figure 5a. (a) Low-power view of adrenocortical adenoma demonstrates the junction (curved arrows) between a rim of well-preserved neoplasm (straight thin arrow) and a large central area of hemorrhage and degenerative changes (straight thick arrow). (Masson trichrome stain.) (b) A closer view of the degenerated area of the adenoma seen in a shows an admixture of pale neoplastic cortical cells arranged in nests (curved arrows) with large areas of eosinophilic fibrin-containing brown hemosiderin pigment, which indicates remote hemorrhage with organization. A few clusters of degenerative tumor cell "ghosts" (straight arrow) are seen. (Masson trichrome stain.) (c) The central area of degeneration in another adrenocortical adenoma contains both foamy macrophages and neoplastic adrenocortical cells, which may look very similar at histologic examination. Cohesive trabecular groups in this field represent tumor cells (arrow). (Hematoxylin-eosin stain.)

View larger version (135K): [in a new window]   Figure 5b. (a) Low-power view of adrenocortical adenoma demonstrates the junction (curved arrows) between a rim of well-preserved neoplasm (straight thin arrow) and a large central area of hemorrhage and degenerative changes (straight thick arrow). (Masson trichrome stain.) (b) A closer view of the degenerated area of the adenoma seen in a shows an admixture of pale neoplastic cortical cells arranged in nests (curved arrows) with large areas of eosinophilic fibrin-containing brown hemosiderin pigment, which indicates remote hemorrhage with organization. A few clusters of degenerative tumor cell "ghosts" (straight arrow) are seen. (Masson trichrome stain.) (c) The central area of degeneration in another adrenocortical adenoma contains both foamy macrophages and neoplastic adrenocortical cells, which may look very similar at histologic examination. Cohesive trabecular groups in this field represent tumor cells (arrow). (Hematoxylin-eosin stain.)

View larger version (148K): [in a new window]   Figure 5c. (a) Low-power view of adrenocortical adenoma demonstrates the junction (curved arrows) between a rim of well-preserved neoplasm (straight thin arrow) and a large central area of hemorrhage and degenerative changes (straight thick arrow). (Masson trichrome stain.) (b) A closer view of the degenerated area of the adenoma seen in a shows an admixture of pale neoplastic cortical cells arranged in nests (curved arrows) with large areas of eosinophilic fibrin-containing brown hemosiderin pigment, which indicates remote hemorrhage with organization. A few clusters of degenerative tumor cell "ghosts" (straight arrow) are seen. (Masson trichrome stain.) (c) The central area of degeneration in another adrenocortical adenoma contains both foamy macrophages and neoplastic adrenocortical cells, which may look very similar at histologic examination. Cohesive trabecular groups in this field represent tumor cells (arrow). (Hematoxylin-eosin stain.)