PART TWO
Diagnostic Cytology
Fig. 27.55 Adrenocortical carcinoma. (A) Coarse granular staining for A103, melan A, calretinin, and inhibin (x MP).
Fig. 27.56 ultrastructure of adrenocortical carcinoma demonstrating
abundant smooth and rough endoplasmic reticulum and mitochondria with
tubulovesicular cristae. These features are typical of steroid-secreting tumors
(x 27 000).
R ecognition o f the characteristic p olyg onal cells helps to m ake
the diagnosis.
W e have aspirated one p heochrom ocytom a th a t d e m o n -
strated a g ang lioneurom atous c om p onent in w h ic h large gan-
g lio n cells w ith eccentric nuclei con tain in g p ro m in e n t nuc le oli
were dispersed in a dense n e u ro fib rilla ry m a trix in a d d itio n to
the pheochrom ocytes (Fig. 27.59A,B).
Im m u n o c h e m istry to dem onstrate the presence o f chrom -
ogranin,
a c onstituent o f the secretory granules,
o r NSE
(Fig. 27.5 9 C) is supportive evidence o f pheochrom ocytom a.
S im ila rly, a G rim e lius stain is positive. U ltrastructurally, pheo-
chrom ocytom as display d istinctive granules corresponding to
norad renaline (n o rep ine p h rine ) and adrenaline (ep inep hrine)
(Fig. 27.58A).
The d iffe re n tia l diagnosis m ay includ e AC C o r m etastatic
m elanom a. P heochrom ocytom as m ay contain m e la n in ,151 in
w h ic h case a p ositive H M B -45 o r S-100 stain m ay lead to an
erroneous conclusion o f m elanom a.
854
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