Adrenal Cortical Rests Research Articles

Adrenal Cortical Rest in Fallopian Tube: An Incidental Rare Finding

Adrenal Cortical Rest in Fallopian Tube: An Incidental Rare Finding

Bilateral adrenal cortical rests: An interesting innocuous intruder in the fallopian tubes.

Ectopic adrenal rests refer to the presence of adrenal tissue outside its normal anatomical location and are usually discovered incidentally on microscopic examination. Literature suggests its occurrence in diverse extrarenal sites, like the genitourinary system and pelvis. Our case describes the rare occurrence of ectopic adrenal rests in the walls of bilateral fallopian tubes of a 43-year-old female patient who presented with a complaint of heavy menstrual bleeding. A total hysterectomy with bilateral salpingo-oophorectomy was performed. Gross examination revealed adenomyosis with multiple fibroids, and the same was confirmed on microscopy. Additionally, the finding of a well-encapsulated lesion on the walls of both tubes made us relook at the fallopian tubes, which showed a small bright yellow area measuring less than 0.3 cm in the walls, which was consistent with ectopic adrenal rests after ruling out the morphological differentials of Walthard cell nests, aggregates of foamy histiocytes, metastatic renal clear cell carcinoma, displaced ovarian luteinized theca cells, heterotopia of ovarian hilus cells. Immunohistochemistry showed positivity for Melan A and CK7 was negative. The present case helps in investigating the lesser-explored aspect of adrenal rest pathology. It also reiterates need for detailed observation of fallopian tubectomy specimens by pathologists during grossing to avoid overlooking of potentially intriguing entities.

Is Routine Pathological Evaluation of Pediatric Hernia Sacs Justified?

Abstract Background/Purpose: Herniorrhaphy is the most common general surgical procedure performed on children, and hernia sac material is one of the most common tissue specimens microscopically examined in the authors' surgical pathology laboratory. The risk of accidental vas deferens ligation has prompted the recommendation that all hernia sacs be examined pathologically. The authors hypothesized that the incidence of unrecognized vas deferens or epididymis ligation is actually very low and may not warrant routine pathological examination of all pediatric hernia sacs. Methods: Over a 3-year period (1994 to 1996), pathology reports from all hernia repairs at the authors' institution were reviewed. A total of 1,494 inguinal hernia sacs were pathologically evaluated from 1,077 pediatric patients (417 were bilateral). Pathological diagnoses not affecting clinical management (ie, chronic inflammation, irritated hernia sacs, embryonal remnants, adrenal cortical rests) were classified as incidental findings. Identification of true vas deferens was classified as a positive finding. Results: The study population had a mean age of 3.9 ± 0.1 years and 963 (89%) were boys. The incidence of vas deferens injury from herniorraphy was found to be 0.13% (2 of 1,494), and these were recognized by the pediatric surgeon in the operating room. Conclusions: When vas deferens injury is suspected, the sample should always be sent to the pathology department for confirmation. However, no occult carcinoma or other pathology was identified, and the remainder of the histological findings did not change the clinical treatment of any child. Given a fixed cost of pathological analysis, elimination of routine hernia sac examination may result in substantial annual savings. Therefore, in the current era of cost containment, recommendations for routine pathological examination of excised pediatric hernia sacs should be reevaluated.

Is routine pathological evaluation of pediatric hernia sacs justified?

Background/Purpose: Herniorrhaphy is the most common general surgical procedure performed on children, and hernia sac material is one of the most common tissue specimens microscopically examined in the authors' surgical pathology laboratory. The risk of accidental vas deferens ligation has prompted the recommendation that all hernia sacs be examined pathologically. The authors hypothesized that the incidence of unrecognized vas deferens or epididymis ligation is actually very low and may not warrant routine pathological examination of all pediatric hernia sacs. Methods: Over a 3-year period (1994 to 1996), pathology reports from all hernia repairs at the authors' institution were reviewed. A total of 1,494 inguinal hernia sacs were pathologically evaluated from 1,077 pediatric patients (417 were bilateral). Pathological diagnoses not affecting clinical management (ie, chronic inflammation, irritated hernia sacs, embryonal remnants, adrenal cortical rests) were classified as incidental findings. Identification of true vas deferens was classified as a positive finding. Results: The study population had a mean age of 3.9 ± 0.1 years and 963 (89%) were boys. The incidence of vas deferens injury from herniorraphy was found to be 0.13% (2 of 1,494), and these were recognized by the pediatric surgeon in the operating room. Conclusions: When vas deferens injury is suspected, the sample should always be sent to the pathology department for confirmation. However, no occult carcinoma or other pathology was identified, and the remainder of the histological findings did not change the clinical treatment of any child. Given a fixed cost of pathological analysis, elimination of routine hernia sac examination may result in substantial annual savings. Therefore, in the current era of cost containment, recommendations for routine pathological examination of excised pediatric hernia sacs should be reevaluated.

Benign testicular tumors in children with congenital adrenal hyperplasia

The association between testicular tumors/nodules and congenital adrenal hyperplasia (CAH) has been previously reported. From 1960 to 1989, three patients (13 to 18 years old) with long-standing CAH developed testicular masses. Two patients with 21-hydroxylase deficiency were diagnosed in the neonatal period while one other with 11-hydroxylase deficiency was diagnosed at 3 years of age when he presented with sexual precocity. In all three patients, medical compliance was poor. The testicular masses were bilateral in two patients and unilateral in one, measured 1 to 2 cm, and occupied only the upper half of the testicle. Testicular biopsy specimens were obtained after at least 6 months of evidence of compliance with the adrenocorticotrophic hormone (ACTH) suppressive medication and failure of the nodules to regress. On gross examination the masses appeared to be firm yellow brown nodules. Light microscopy showed interlacing strands, cords, and rests of cells resembling interstitial (Leydig) cells but with no Reinke crystal-loids. Electronmicroscopy in all patients showed variable amounts of both smooth and rough endoplasmic reticulum, the later with occasional dilated cisternae. Follow-up ranged from 6 months to 6 years. No further surgical treatment has been necessary. There has been no evidence of recurrence, distant metastases, or secondary malignancies during the time of follow-up. These findings suggest that testicular tumors may develop from chronic excessive ACTH stimulation of a putative pluripotential testicular cell, a Leydig cell, or an adrenal cortical rest. Unlike other testicular tumors these do not require orchiectomy as the initial form of therapy.

Splenic-gonadal fusion and adrenal cortical rest associated with bilateral cryptorchism

A patient with bilateral cryptorchism had ectopic splenic tissue adherent to his left testicle and an adrenal cortical rest adherent to his right testicle. The embrylogic basis for these disorders is discussed and the literature reviewed.

An adrenal cortical rest within the fetal ovary: report of a case.

The presence of heterotopic adrenal cortical tissue within the fetal ovary is recorded. The embryologic basis for this observation and its possible significance are discussed.

Adrenal Cortical Rests of the Ovarian Hilus of the Patas Monkey

Adrenal Cortical Rests of the Ovarian Hilus of the Patas Monkey

Adrenal-like ovarian tumor associated with cushing's syndrome (so-called masculino-voblastoma, luteoma, hypernephroma, adrenal cortical carcinoma of the ovary)

Like arrhenoblastomas, the adrenal-like ovarian tumors tend to masculinize their hosts but the tendency toward the production of a bizarre type of fat distribution, the occurrence of purplish striae, arterial hypertension, polycythemia and so forth, relate them more closely to adrenal cortical carcinomas from a functioning standpoint. Histologically, the tumors do not appear to arise through luteinization of pre-existing granulosa-cell neoplasms and an origin from adrenal cortical rests seems more logical than does a derivation from corpora lutea. An origin by way of teratomatous development likewise remains unproved. Some of the tumors appear to be cytologically malignant and in one instance death resulted from metastasis.