Laboratory findings Hormonal syndromes should be confirmed with laboratory testing. Laboratory findings in Cushing syndrome include increased serum glucose (blood sugar) and increased urine cortisol. Adrenal virilism is confirmed by the finding of an excess of serum androstenedione and dehydroepiandrosterone. Findings in Conn syndrome include low serum potassium, low plasma renin activity, and high serum aldosterone. Feminization is confirmed with the finding of excess serum estrogen. Imaging Radiological studies of the abdomen, such as CT scans and magnetic resonance imaging are useful for identifying the site of the tumor, differentiating it from other diseases, such as adrenocortical adenoma, and determining the extent of invasion of the tumor into surrounding organs and tissues. On CT, it shows heterogeneous appearance due to necrosis, calcifications, and haemorrhage. After contrast injection, it shows peripheral enhancement. Invasion of adjacent structures such as kidney, vena cava, liver, and retroperitoneal lymph nodes are also common. On MRI, it shows low intensity on T1-weighted images, and high T2 signal with strong heterogeneous contrast enhancement and slow washout. Haemorrhagic areas may show high T1-signal. Pathology Gross view of a large<unk>  Cell-block preparation from a fine-needle aspiration biopsy of a large<unk>  shows tumor cells with compact, eosinophilic cytoplasm and a mild degree of nuclear pleomorphism. Adrenal tumors are often not biopsied prior to surgery, so diagnosis is confirmed on examination of the surgical specimen by a pathologist. Grossly,<unk> s are often large, with a tan-yellow cut surface, and areas of hemorrhage and necrosis. On 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 mitotic activity help differentiate small cancers from adrenocortical adenomas. Several relatively rare variants of<unk>  include: * Oncocytic adrenal cortical<unk>  * Myxoid adrenal cortical<unk>  *<unk> rcoma * Adenosquamous<unk>  * Clear cell adrenal cortical<unk>  Differential diagnosis Incidences and prognoses of adrenal tumors, with<unk>  at top. Differential diagnosis includes: * Adrenocortical adenoma * Renal cell<unk>  * Pheochromocytoma * Hepatocellular<unk> <unk> s are most commonly distinguished from adrenocortical adenomas (their benign counterparts) by the Weiss system, as follows: Characteristic Score High nuclear grade (enlarged, oval to lobated, with coarsely granular to hyperchromatic chromatin and easily discernible, prominent nucleoli) 1 More mitoses than 5/50 high power fields 1 Atypical mitoses 1 Eosinophilic cytoplasm in >75% of tumor cells 1 Diffuse architecture of >33% of tumor 1 Necrosis 1 Venous invasion 1 Sinusoidal invasion (no smooth muscle in wall) 1 Capsular invasion 1 Total score indicates: * 0-2: Adrenocortical adenoma * 3: Undetermined * 4-9:<unk>
Adrenocortical carcinoma
Adrenocortical adenoma
Renal oncocytoma
Nephrogenic adenoma
Renal medullary carcinoma
Metanephric adenoma
Renal medullary fibroma
Mastocytoma