Fallopian tubes & broad ligament
Broad ligament tumor-like lesions
Adrenocortical remnants
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PubMed search: Adrenocortical remnants
Table of Contents
Definition / general | Essential features | Terminology | Epidemiology | Sites | Pathophysiology | Etiology | Clinical features | Diagnosis | Laboratory | Radiology description | Prognostic factors | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Virtual slides | Cytology description | Positive stains | Negative stains | Sample pathology report | Differential diagnosis | Practice question #1 | Practice answer #1Cite this page: Li JJX, Ip PPC. Adrenocortical remnants. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/fallopianbroadligamentadrenocorticalremnants.html. Accessed September 2nd, 2025.
Definition / general
- Adrenal tissue present in the broad ligament or fallopian tube
Essential features
- Resembles normal adrenal tissue
- Usually an incidental finding in operative specimens for other clinical conditions
- Rarely symptomatic and presents mostly secondary to other endocrine conditions (adrenocorticotropic hormone [ACTH] production) or upon malignant transformation
Terminology
- Heterotopic adrenal tissue
- Ectopic adrenal rest, adrenal rest, adrenal cortical rest, adrenocortical rest
Epidemiology
- Present in up to 23% of broad ligaments at total hysterectomy (Cancer 1955;8:143)
Sites
- In women, adrenocortical remnants are reported in ovary adnexa and broad ligament, kidney, liver, lungs, mediastinum, stomach, placenta and spinal cord (J Clin Res Pediatr Endocrinol 2022;14:258)
Pathophysiology
- Multiple suggested pathogeneses (J Clin Res Pediatr Endocrinol 2022;14:258)
- Misplaced mesodermal cells (Virchows Arch A Pathol Anat Histol 1974;363:371)
- Migration of adrenal primordium (Hepatol Res 2008;38:1154)
- Self differentiation of mesothelial cells (World J Gastroenterol 2013;19:778)
Etiology
- Conditions causing ACTH production will lead to hyperplasia in existing ectopic adrenal tissue but are unlikely to be the direct cause (Am J Med 1982;73:455)
Clinical features
- Most cases of broad ligament adrenocortical remnants are asymptomatic without functional symptoms (Cureus 2022;14:e27649)
- Symptoms rare but reported in adrenocortical remnants of other sites (Diagn Pathol 2016;11:40)
- Nelson syndrome due to activation of virilizing adrenocortical remnants (Am J Med 1982;73:455)
- Other possible presentations include (Int J Surg Case Rep 2020;72:66)
- Recurrence of Cushing syndrome after adrenalectomy due to secondary hyperplasia or adrenocortical remnants
- Regression of adrenal glands due to hyperfunctioning adrenocortical remnants
- Neoplastic transformation of adrenocortical remnants
Diagnosis
- Diagnosis by histopathological examination
Laboratory
- Most cases of broad ligament adrenocortical remnants do not result in hormonal abnormalities (Cureus 2022;14:e27649)
Radiology description
- Nonspecific and often not recognized on imaging unless large in size or clinically suspected (J Clin Endocrinol Metab 2012;97:E2084, Pathol Int 1997;47:493, Horm Metab Res 2021;53:161)
- Cosyntropin stimulation with 18F-FDG or NP59 positron emission tomography / computed tomography (PET / CT) scan can be used to identify ectopic adrenal tissue (J Clin Endocrinol Metab 2012;97:E2084, Horm Metab Res 2021;53:161)
Prognostic factors
- Benign unless malignant transformation to adrenocortical carcinoma
Case reports
- 21 year old woman with chocolate cyst of the right ovary (J Microsc Ultrastruct 2022;11:118)
- 37 year old woman with pelvic pain (Medicines (Basel) 2021;8:14)
- 48 year old woman with heavy menstrual bleeding (J Obstet Gynaecol 2018;38:578)
- 49 year old woman with adenomyosis and hysterectomy (Cureus 2022;14:e27649)
- 76 year old woman with vaginal bleeding (Oxf Med Case Reports 2024;2024:omae024)
Treatment
- Treated by surgical removal
Gross description
- Encapsulated and circumscribed mass (Pathol Int 1997;47:493)
- Golden yellow cut surface (Pathol Int 1997;47:493)
Gross images
Images hosted on other servers:
Fallopian tube and ovary
Microscopic (histologic) description
- Resembles normal adrenal cortical tissue without adrenal medulla
- Small nests of polygonal clear to eosinophilic cells with bland nuclear features
Microscopic (histologic) images
Contributed by Joshua J. X. Li, M.B.Ch.B. and Philip P. C. Ip, M.B.Ch.B.
Encapsulated nodules
Distinct nodule
Nested pattern
Clear cytoplasm
Eosinophilic cells
Resembles adrenal cortex
Virtual slides
Images hosted on other servers:
Adrenocortical rest in the uterine adnexa
Cytology description
- Adrenocortical remnants in the broad ligament and fallopian tubes are rarely approached by fine needle aspiration
- Aspirates from adrenocortical remnants in other locations resemble normal adrenal cortex (Diagn Cytopathol 2011;39:849)
- Large cells with granular cytoplasm
- Eccentric nuclei
Positive stains
Sample pathology report
- Fallopian tube, salpingectomy:
- Adrenocortical remnants (see comment)
- Comment: Sections show well circumscribed encapsulated nodules composed of nests of clear to eosinophilic tumor cells. The tumor cells show bland nuclear features. Mitotic figures and necrosis are not apparent. The features are those of adrenocortical remnants.
Differential diagnosis
- Adrenocortical carcinoma:
- Malignant histological features (Weiss criteria)
- High grade nuclei
- Increased mitotic figures
- Atypical mitoses
- Clear or vacuolated cells (≤ 25% of tumor)
- Diffuse architecture (> 33% of tumor)
- Necrosis
- Venous invasion
- Sinusoidal invasion
- Capsular invasion
- Presence of benign adrenocortical component may be supportive of primary malignant transformation of adrenocortical remnants
- Malignant histological features (Weiss criteria)
- Paraganglioma:
- Positive for neuroendocrine markers (synaptophysin, chromogranin, CD56)
- Negative for cytokeratin
- Renal cell carcinoma:
- Positive for PAX8
- Negative for MelanA, calretinin, SF1
Practice question #1
Which of the following features differentiates adrenocortical remnants from renal cell carcinoma?
- Bland nuclear features in tumor cells
- Negativity for WT1
- Positivity for SF1
- Tumor cells showing abundant clear cytoplasm
Practice answer #1
C. Positivity for SF1. SF1 is positive in steroidogenic tissue including the adrenal cortex but not in renal cell carcinoma.
Answer B is incorrect because both entities are negative for WT1.
Answer A is incorrect because adrenocortical remnants and renal cell carcinomas with low grade nuclei (i.e., WHO / ISUP or Fuhrman grade I) do not display significant nuclear atypia.
Answer D is incorrect because adrenocortical adenoma and clear cell renal cell carcinoma consist of tumor cells with abundant clear cytoplasm.
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Reference: Adrenocortical remnants
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Reference: Adrenocortical remnants
