Wednesday 4 April 2012
Benign adrenocortical tumors may be associated with syndromes of virilization or feminization, but the presence of a pure adrenogenital syndrome, particularly feminization, should raise the possibility of malignancy.
Some authors, in fact, consider all feminizing cortical neoplasms to be potentiallymalignant.
Virilizing adenomas are generally larger than those found in the context of pure Cushing syndrome, and a few adenomas associated with adrenogenital syndromes have weighed up to 500g.
Similar to tumors associated with glucocorticoid overproduction, virilizing adenomas are sharply circumscribed or encapsulated; however, they tend to be red-brown rather than yellow on cross section.
Smaller tumors have an alveo-lar pattern of growth, whereas larger tumors tend to have more solid or diffuse growth patterns.
Although most tumor cells have a low nuclear-to-cytoplasmic ratio, single cells and small cell groups may exhibit nuclear enlargement and hyperchromasia.
The cytoplasm is usually eosinophilic and granular.
Rare virilizing tumors contain Reinke crystalloids and have been termed
Leydig cell adenomas similar to their testicular counterparts.
On ultrastructural examination, the mitochondria are of the tubulolamellar type.
Sex steroid–producing adenomas are not associated with atrophy of the adjacent cortex or the contralateral adrenal gland.