Low power: DQ stain
Cohesive clusters of normal adrenal cells
D/D adrenal hyperplastic nodule vs adenoma
Medium power: Pap stain
Cohesive clusters of normal adrenal cells
Note small round uniform cells with mild variation in size. Presence of intranuclear cytoplasmic inclusion
Medium power: Pap stain
Cohesive clusters of normal adrenal cells
Note endocrine atypia with variation in size and traversing vessels
High power: Pap stain
Cohesive clusters of normal adrenal cells
Small round uniform cells, fine chromatin and inconspicuous nucleoli
Cell block: H&E stain
Clusters of adrenal cells
D/D adrenal hyperplastic nodule vs adenoma. Clinical/radiological correlation is required
Features
• Cohesive aggregates of normal looking adrenal cells
• Predominantly naked nuclei in a frothy background
• Rare intact single cells
• Low N:C ratios
• Usually small and round
• Uniform cells but may have endocrine atypia
• Vacuolated cytoplasm, easily stripped
• May have granular cytoplasm
• Small round nuclei
• Fine chromatin
• Inconspicuous nucleoli
• May have intranuclear cytoplasmic inclusions
• Naked nuclei commonly present
• Foamy background
• May have vessels traversing through cell aggregates
• Usually necrosis and mitosis absent
• Positive for Inhibin (cytoplasmic), Melan A (cytoplasmic), calretinin (cytoplasmic and nuclear), synaptophysin (cytoplasmic)
• Negative for AE1/AE3 (cytoplasmic) and chromogranin (cytoplasmic)
• Cytology of hyperplastic and neoplastic adrenal glands are indistinguishable and require clinical/radiological correlation
Katz RL et al. Acta Cytol. 1984 May-Jun;28(3):269-82.
Stelow EB. et. Al. Diagn Cytopathol. 2005 Jul;33(1):26-30.
Fassina AS. et. al. Cytopathology. 2000 Oct;11(5):302-11.