Flashcards in Adrenal Deck (131)
Neuroblastoma: Histologic architecture.
Cells are arranged in vague lobules and may form Homer Wright rosettes (filled with pink fibrillary matter).
Five-year survival rate
− Benign: 95%.
− Malignant: 44%.
Undifferentiated and pleomorphic.
Neuroblastoma: Undifferentiated (2).
Neuroblasts show no differentiation toward ganglion cells.
Neuroblastoma: Undifferentiated and pleomorphic.
Same as undifferentiated neuroblastoma, except that neuroblasts are larger and more pleomorphic and have more cytoplasm.
Neuroblastoma: Poorly differentiated.
Fewer than 5% of neuroblasts show differentiation toward ganglion cells.
More than 5% of neuroblasts show differentiation toward ganglion cells.
Mitosis-karyorrhexis index: Number of cells to be counted.
Mitosis-karyorrhexis index: Ranges.
Low: Less than 2%.
High: More than 4%.
Neuroblastoma: Mutation that confers poor outcome.
Amplification of MYCN (more than 10 copies).
Prognosis of neuroblastoma: Patient over 5 years of age.
Any neuroblastoma is considered to have unfavorable histology.
Prognosis of neuroblastoma: Patient between 18 months and 5 years of age, inclusive (3).
Undifferentiated or poorly differentiated: Unfavorable histology.
Differentiating: Favorable as long as the MKI is low (i.e. not intermediate or high).
Prognosis of neuroblastoma: Patient under 18 months of age (3).
Undifferentiated: Unfavorable histology.
Poorly differentiated or differentiating: Favorable as long as the MKI is low or intermediate.
Any tumor with a high MKI: Unfavorable.
Prognosis of neuroblastoma: DNA index.
A. Used in patients under 1 year of age.
B. Hyperdiploidy or near-triploidy is better than near-diploidy or near-tetraploidy.
Prognosis of neuroblastoma: Expression of TRK.
TRK A, B, and C: Low or absent expression imparts poorer prognosis.
Neuroblastoma: Extracellular components (2).
Fibrillar matrix resembling neuropil.
Delicate fibrovascular septa separating the lobules.
Neuroblastoma: Definition of stage 4S.
Small, localized primary tumor with metastases to liver, skin, or bone marrow that nearly always spontaneously regress.
Neuroblastoma: Immunohistochemistry of tumor cells (5,2).
Positive: NSE, synaptophysin, chromogranin, neurofilament, Neu-N.
Negative: Cytokeratins and other non-neural markers.
Neuroblastoma: Associated hereditary syndromes (4).
Congenital central hypoventilation.
Neuroblastoma: Electron microscopy (3).
Primary melanoma of the adrenal gland: Criteria (4).
No previous melanoma.
No endocrine disorder.
No doubt about histology.
Primary melanoma of the adrenal gland: Gross pathology.
Often locally advanced at presentation, with renal adhesions.
Primary melanoma of the adrenal gland: Prognosis.
Death within 2 years.
Primary melanoma of the adrenal gland vs. pigmented adrenal cortical adenoma: Immunohistochemistry (3).
Both are positive for Melan-A.
Adenoma is negative for S100, HMB-45.
Primary melanoma of the adrenal gland vs. pheochromocytoma: Immunohistochemistry.
Both are positive for HMB-45.
The sustentacular cells of pheochromocytoma are positive for S-100.
Myelolipoma: Age group.
Myelolipoma: Presentation (2).
Rarely causes Cushing's syndrome or Conn's syndrome.
A. Gross pathology.
A. Red and yellow cut surface.
B. Mature bone marrow and mature fat.
Adenolipoma combines myelolipoma and adrenal cortical adenoma.