Hansel Donna E, Reuter Victor E
*Department of Pathology, University of California at San Diego, La Jolla, CA †Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY.
Adv Anat Pathol. 2016 Sep;23(5):273-84. doi: 10.1097/PAP.0000000000000120.
Adrenal gland diagnostics can pose significant challenges. In most academic and community practice settings, adrenal gland resections are encountered less frequently than other endocrine or genitourinary specimens, leading to less familiarity with evolving classifications and criteria. The unique dichotomy between cortical and medullary lesions reflects the developmental evolution of these functionally independent components. Adrenal cortical lesions at resection include hyperplasia, adenoma, and carcinoma, with some cases straddling the boundary between these distinct clinical classifications. The lack of immunohistochemical or molecular markers to definitively categorize these intermediate lesions enhances the diagnostic challenge. In addition, modified terminology for oncocytic and myxoid cortical lesions has been proposed. Medullary lesions are somewhat easier to categorize; however, the prediction of aggressive behavior in pheochromocytomas remains a challenge due to a lack of reliable prognostic biomarkers. Recent work by the Cancer Genome Atlas Project and other research groups has identified a limited subset of molecular and signaling pathway alterations in these 2 major neoplastic categories. Ongoing research to better define prognostic and predictive biomarkers in cortical and medullary lesions has the potential to enhance both pathologic diagnosis and patient therapy.
肾上腺诊断可能带来重大挑战。在大多数学术和社区实践环境中，肾上腺切除术比其他内分泌或泌尿生殖系统标本的切除术更少见，这导致对不断演变的分类和标准不太熟悉。皮质和髓质病变之间独特的二分法反映了这些功能独立成分的发育演变。切除时的肾上腺皮质病变包括增生、腺瘤和癌，有些病例跨越了这些不同临床分类之间的界限。缺乏免疫组化或分子标志物来明确分类这些中间病变增加了诊断难度。此外，有人提出了关于嗜酸细胞性和黏液样皮质病变的改良术语。髓质病变在某种程度上更容易分类；然而，由于缺乏可靠的预后生物标志物，嗜铬细胞瘤侵袭性的预测仍然是一个挑战。癌症基因组图谱项目和其他研究小组最近的工作已经确定了这两大类肿瘤中有限的分子和信号通路改变子集。正在进行的关于更好地定义皮质和髓质病变的预后和预测生物标志物的研究有可能改善病理诊断和患者治疗。
