Laboratory

Laboratory

Chemistry
Test	Value
Sodium	139
Potassium	4.8
Chloride	H 108
Bicarbonate	27
Anion Gap	4.0
Urea	H 16.0
Creatinine	H 127
Albumin	35
Calcium	2.37
Glucose, Random	5.8

Hematology
Test	Value
LKC	7.0
ERC	L 3.49
Hemoglobin	L 105
HCT	L 0.32
MCV	91.7
RDW	12.5

Enzymes and Cardiac Markers
Test	Value
ALT	H 128
CK	64

Urine
Test	Value
Appearance	Cloudy
Color	Yellow
Leukocytes, U	0 cells/uL
Sp Gravity, U	1.020
pH, U	5.5
Protein, U	>+3.0 g/L
Glucose, U	0.0 mmol/L
Ketones, U	0.0 mmol/L
Blood, U	# Small
Nitrate, U	Negative
Osmolality, U	418
Sodium, U	89
Potassium, U	37
Chloride, U	L 98

Pathology

 

Specimen: Left adrenal gland

 

Clinical information:  Conn's tumor.

 

Gross Description

Specimen consists of an adrenal gland and associated adipose tissue.  The specimen in total measures 8.7 X 3.0 X 3.0 c.  Within the adrenal tissue lies a well-circumscribed, nodular lesion measuring 2.3 X 2.3 X 2.2 cm. There is apparent compression of the adjacent adrenal tissue, with thinning of the overlying cortical tissue to a width of only about 1 mm.  At closest approach, the lesion measures 1 mm from the inked resection margin.  The cut surface of the nodule is mainly yellow and lobulated, with small brown-black regions of probable hemorrhage. 

 

Representative sections submitted as follows:  blocks (A1 to A9) - adrenal nodule, submitted in its entirety (nearest inked resection margins in blocks (A4, A5); block (A10) - representative sections of remaining, grossly unremarkable adrenal tissue and associated fat.

 

Microscopic Description

Sections show a 2.3 cm well circumscribed nodular lesion present within an adrenal gland.  The lesion is partially encapsulated by fibrous capsule.  Composition consists of both lipid rich and lipid poor cells arranged in irregular cords, trabeculae, and alveolar nests and composed of a heterogeneous cell population.  There are large lipid rich cells and smaller cells with sparse lipid.  In addition, occasional cells have compacted eosinophilic cytoplasm.  All of the cells have similar monomorphic oval nuclei with a vesicular chromatin pattern and small indistinct nucleoli.  Marked nuclear atypia and mitotic activity is not identified.  The lesion has expanded and compressed the adjacent adrenal gland.

 

Comment

The histological features are consistent with an adrenal cortical neoplasm.  The lesion measures 2.3 cm in greatest dimension.   It is difficult to predict the biologic behavior of this type of neoplasm.  However, this particular lesion does not exhibit marked nuclear atypia, necrosis and mitotic activity.  Definitive vascular invasion is not identified.  In addition, according to the surgical requisition, the lesion is functioning.  Therefore, an adrenal cortical adenoma is favored.

 

Final Diagnosis

Left adrenal gland, resection: adrenal cortical neoplasm, favor adrenal cortical adenoma.