Diagnosis

Diagnosis

Pheochromocytoma.

Discussion

The gross photo demonstrates a well-circumscribed, gray-pink mass within the medulla of the adrenal gland. Adrenal pheochromocytomas are medullary-based tumors and depending on size may be encapsulated (larger tumors) or unencapsulated (smaller tumors). Pheochromocytomas are known as the 10% tumor: 10% are bilateral, 10% are extra-adrenal, 10% occur in children, and 10% are malignant.

The main tumors in the gross differential diagnosis of a pheochromocytoma are: adrenal cortical adenoma (ACA) or carcinoma (ACC) and metastatic tumors. The main differentiating gross feature for both ACC and ACA, as the name implies, is an origin within the adrenal cortex versus the medulla for pheochromocytoma. ACAs tend to have a bright yellow and homogeneous color. Rarely, ACA is pigmented (due to lipofuscin or neuromelanin pigments). ACCs are also yellow but may have a variegated appearance due to necrosis and/or hemorrhage and tend to be larger than ACAs. Metastases to the adrenal gland are only rarely resected and typically are carcinomas from the lung or breast or metastatic melanoma. Metastases may be multiple and are typically tan-white and firm with infiltration into the adjacent adrenal gland.

References

Susan C. Lester, Manual of Surgical Pathology, 3rd Edition. W.B. Saunders, 2010.
 

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