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