Adrenal gland and paraganglia
Adrenocortical adenoma
Myxoid

Author: Carmen Perrino, M.D. (see Authors page)

Editor: Debra Zynger, M.D.

Revised: 15 January 2016, last major update April 2014

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Adrenocortical adenoma myxoid
General
  • Adrenal cortical adenoma (ACA) with ≥10% myxoid area
  • Most reported cases are adrenal cortical carcinomas (ACC) (Virchows Arch 2012;460:9)
Epidemiology
Sites
  • Adrenal cortex, all 3 layers
Pathophysiology
  • Origin of myxoid areas unknown
Clinical Features
Diagnosis
  • ACA with ≥10% myxoid area
Laboratory
  • Depends on if the tumor is functional, and what hormones it secretes (see ACA General)
Radiology Description
Prognostic Factors
  • Of note, myxoid changes more common in adrenocortical carcinoma
  • Weiss Criteria (see ACA General), although may not be as reliable in myxoid tumors
Case Reports
Treatment
Gross Description
  • Size and weight similar to ACA (generally <100 grams, <7.5 cm) (Am J Surg Pathol 2000;24:396)
  • Cut surface has some gray, gelatinous areas consistent with myxoid areas
Micro Description
  • Clusters of tumor cells floating in acellular, myxoid background
  • Myxoid areas ranges from 10% to >90%
  • Foci of conventional ACA cells, with tumor cells arranged in cords, trabeculae, nests, pseudo-glands (nests with central lumen filled with myxoid matrix)
Micro Images

Images hosted on other servers:

H&E

Various stains

Cytology Description
  • Loose aggregates of pale, large, round to oval cells with delicate vacuolated cytoplasm, centrally located nuclei, a single nucleoli, and extracellular myxoid material (Diagn Cytopathol 2008;36:576)
  • Extracellular myxoid material is highlighted with Alcian blue, digested by hyaluronidase, and is PAS+ (Diagn Cytopathol 2008;36:576)
Positive Stains
  • Myxoid component: Alcian blue
  • Tumor cells: synaptophysin, inhibin, vimentin
Negative Stains
  • Myxoid component (negative or focally weak): PAS, mucicarmine
  • Tumor cells: cytokeratin
Electron Microscopy Description
  • Very few cases reported, not specifically studied
Molecular / Cytogenetics Description
  • Very few cases reported, not specifically studied
Differential Diagnosis