Pathology

Both benign and malignant tumours are seen in the adrenal gland and, in the hereditary variants, hyperplasia and pre-malignant changes may be evident. The differentiation between benign and malignant tumours is usually only made by their clinical behaviour— the presence of local invasion or metastases indicates a malignant tumour.

Only about 10% of adrenal medullary tumours are malignant. The hereditary tumours often occur in younger age groups, are more likely to be bilateral, and tend to be more benign in their behaviour. Adreno-medullary tumours are usually phaeochromocytomas, so-called because of their golden or tan-coloured appearance. About 10% of phaeochromocytomas are extra-adrenal and arise anywhere in the sympathetic chain. Rarely, neuroblastomas may present in late adolescence or adulthood. Immunocytochemistry is important in establishing the diagnosis. Adrenocortical carcinomas are usually adenocarcinomas and malignancy is confirmed by the presence of metastatic spread. These tumours extend locally to nodes and the liver but have a high frequency of distant spread when malignant.

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