TUMORS OF THE ADRENAL GLAND
AND EXTRA-ADRENAL PARAGANGLIA

by

ERNEST E. LACK, M.D.
Director of Anatomic Pathology and
Professor of Pathology
Georgetown University School of Medicine
Washington, D.C. 20007


Table of Contents

1 Developmental, Physiologic, and Anatomic Aspects of Adrenal Cortex and
  Medulla
  1.1 Embryology and Biosynthetic Pathways
    1.1.1 Embryologic Development of the Adrenal Cortex
    1.1.2 Biosynthetic Pathway of Adrenal Corticosteroids
    1.1.3 Embryologic Development of Adrenal Medulla
    1.1.4 Biosynthesis of Catecholamines
  1.2 Function of Fetal Adrenal Glands
  1.3 Anatomy of Adrenal Glands
    1.3.1 Adrenal Weight
    1.3.2 Gross Anatomy
    1.3.3 Microscopic Anatomy
    1.3.4 Immunohistochemistry and Distribution of Steroidogenic Enzymes
  1.4 Miscellaneous Microscopic Features
    1.4.1 Adrenal Cytomegaly
    1.4.2 Focal "Adrenalitis"
    1.4.3 Ovarian Thecal Metaplasia
  1.5 Electron Microscopy
    1.5.1 Electron Microscopy of Adrenal Cortex
    1.5.2 Electron Microscopy of Adrenal Medulla
2 Congenital Adrenal Heterotopia, Hyperplasia, and Beckwith-Wiedemann
  Syndrome
  2.1 Adrenal Adhesion, Union, and Fusion
  2.2 Heterotopic and Accessory Adrenal Tissues
  2.3 Congenital Adrenal Hyperplasia
    2.3.1 Pathology of Adrenal Glands in CAH
  2.4 Occurrence of Tumors in the Setting of CAH
    2.4.1 Adrenal Cortical Neoplasms
    2.4.2 Testicular Tumors in CAH
  2.5 Beckwith-Wiedemann Syndrome
3 Adrenal Cortical Nodules and Tumor-like Lesions
  3.1 Adrenal Cortical Hyperplasia
  3.2 Adrenal Cortical Nodule (or Adenoma) with Eucorticalism
    3.2.1 Adrenal Cortical Nodule at Autopsy
    3.2.2 Incidental Pigmented Cortical Nodules
    3.2.3 Serendipitous Cortical Nodule Discovered In Vivo
  3.3 Adrenal Cortical Hyperplasia with Hypercortisolism
    3.3.1 Pituitary-Dependent Hypercortisolism
    3.3.2 Macronodular Hyperplasia with Marked Adrenal Enlargement
    3.3.3 Primary Pigmented Nodular Adrenocortical Disease (PPNAD)
  3.4 The Complex of Myomas, Spotty Pigmentation, and Endocrine
      Overactivity
  3.5 Ectopic ACTH Syndrome with Hypercortisolism
  3.6 Multiple Endocrine Neoplasia Syndrome Type I
  3.7 Adrenal Hyperfunction with Primary Hyperaldosteronism
  3.8 Unilateral Adrenal Cortical Hyperplasia
4 Adrenal Cortical Adenoma
  4.1 Adrenal Cortical Adenoma with Cushing's Syndrome
  4.2 Functional Pigmented ("Black") Adenoma
  4.3 Adrenal Cortical Adenoma with Primary Hyperaldosteronism
      (Conn's Syndrome)
  4.4 Adrenal Cortical Neoplasms with Virilization or Feminization
  4.5 Oncocytic Adrenal Cortical Adenoma
5 Adrenal Cortical Carcinoma
  5.1 Unusual Variants
    5.1.1 Oncocytic Adrenal Cortical Carcinoma
    5.1.2 Adrenal Carcinosarcoma
    5.1.3 Adrenal Cortical Blastoma
6 Adrenal Cortical Neoplasms in Childhood
  6.1 Hemihypertrophy and Other Abnormalities
  6.2 Beckwith-Wiedemann Syndrome and Adrenal Cytomegaly
  6.3 Cancer Family Syndrome (Li-Fraumeni or SBLA Syndrome)
  6.4 Congenital Adrenal Hyperplasia
  6.5 Adrenal Cortical Blastoma
7 Other Neoplasms and Tumor-like Lesions of the Adrenal Glands
  7.1 Adrenal Enlargement Due to Infection or Abscess Formation
  7.2 Adrenal Enlargement Due to Hemorrhage and Hematoma Formation
  7.3 Adrenal Cysts
  7.4 Myelolipoma
  7.5 Primary Malignant Melanoma
  7.6 Primary Malignant Lymphoma
  7.7 Primary Mesenchymal Tumors
    7.7.1 Vascular Neoplasms
    7.7.2 Smooth Muscle Neoplasms
  7.8 Other Unusual Primary Adrenal Tumors
    7.8.1 Neural Tumors
    7.8.2 Adenomatoid Tumor
    7.8.3 Other Rare Primary Tumors
8 Tumors Metastatic to Adrenal Glands
  8.1 Incidence and Primary Sites of Tumors Metastatic to Adrenal Glands
  8.2 Secondary Adrenal Cortical Insufficiency (Addison's Disease)
  8.3 Involvement of Adrenal Glands by Malignant Lymphoma and Leukemia
  8.4 Secondary Involvement by Other Malignant Tumors
9 Adrenal Medullary Hyperplasia and Multiple Endocrine Neoplasia (MEN)
  Syndrome Type II
  9.1 Sporadic Adrenal Medullary Hyperplasia
  9.2 Familial Adrenal Medullary Hyperplasia
    9.2.1 Multiple Endocrine Neoplasia (MEN) Syndromes
    9.2.2 Pathology of AMH and Distinction from Pheochromocytoma
  9.3 Proliferative Lesions of Adrenal Medulla in Rats
10 Pheochromocytoma
  10.1 Sporadic Pheochromocytoma
  10.2 Familial Pheochromocytoma
    10.2.1 Pheochromocytomas in MEN Syndrome Types IIa and IIb
    10.2.2 MEN Syndrome Type IIb
    10.2.3 Other Associated Endocrine Disorders
  10.3 The Triad of Gastric Epithelioid Leiomyosarcoma, Pulmonary
       Chondroma, and Functioning Extra-adrenal Paraganglioma
  10.4 Composite Pheochromocytoma
  10.5 Pheochromocytomas in Childhood
  10.6 Pseudopheochromocytoma
  10.7 Malignant Pheochromocytoma
11 Extra-adrenal Paraganglia of the Sympathoadrenal Neuroendocrine System
12 Extra-adrenal Paragangliomas of the Sympathoadrenal Neuroendocrine
   System
  12.1 Extra-adrenal Intra-abdominal Paragangliomas
    12.1.1 Urinary Bladder Paragangliomas
    12.1.2 Unusual Abdominal and Pelvic Sites of Paragangliomas
  12.2 Intrathoracic Paravertebral Paragangliomas
  12.3 Cervical Paravertebral Paragangliomas
  12.4 Unusual Neoplasms
    12.4.1 Gangliocytic Paraganglioma
    12.4.2 Paraganglioma of Cauda Equina
  12.5 Glomus Coccygeum
13 Ultrastructural and Other Features of Sympathoadrenal Paragangliomas
14 Paraganglia of the Head and Neck Region
  14.1 Paraganglia as Part of a Diffuse Neuroendocrine System
  14.2 Physiologic Function in Experimental Animals
  14.3 Physiologic Function of Chemoreceptors in Humans
  14.4 Nomenclature of Paragangliomas
15 Carotid Body Paraganglia
  15.1 Normal Anatomy of Carotid Body Paraganglia
  15.2 Hyperplasia of Carotid Body Paraganglia
  15.3 Risk for Development of "Chemodectoma" Under Normobaric Conditions
16 Carotid Body Paraganglioma
17 Jugulotympanic Paraganglioma
  17.1 Jugulotympanic Paraganglia
  17.2 Clinical Features of Jugulotympanic Paraganglioma
  17.3 Tympanic Paraganglioma
  17.4 Jugular Paraganglioma
  17.5 Other Intracranial Paragangliomas
  17.6 Hormonal Manifestations
  17.7 Pathology of Jugulotympanic Paraganglioma
  17.8 Biologic Behavior and Treatment of Jugulotympanic Paraganglioma
18 Vagal Paraganglioma
  18.1 Vagal Paraganglia
  18.2 Parathyroid Tissue Within the Vagus Nerve
  18.3 Vagal Paraganglioma
19 Laryngeal Paraganglioma
  19.1 Laryngeal Paraganglia
  19.2 Laryngeal Paraganglioma
20 Aorticopulmonary Paraganglioma
  20.1 Aorticopulmonary Paraganglia
  20.2 Aorticopulmonary Paraganglioma
  20.3 The Endocrine Lung and Pulmonary Chemoreceptors: Innervated
       Clusters of Pulmonary Neuroendocrine Cells
  20.4 Pulmonary Paraganglia
  20.5 Pulmonary Paraganglioma
21 Paragangliomas in Other Sites in the Head and Neck Region
  21.1 Orbital Paraganglioma
  21.2 Paragangliomas of Nasal Cavity and Nasopharynx
  21.3 Primary Thyroid Paraganglioma
  21.4 Paragangliomas in Other Locations
22 Ultrastructural and Other Features of Paragangliomas of the Head and
   Neck Region
23 Neuroblastoma, Ganglioneuroblastoma, and Other Related Tumors
  23.1 Neuroblastoma and Ganglioneuroblastoma
  23.2 Ganglioneuroma
  23.3 Masculinizing Ganglioneuroma
24 Index

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