Most common lesions are adenomas (yellow), pheochromocytoma (red), and cortical hyperplasia. Malignancy should be suspected if multiple nodules, any tumor with necrosis, adrenal capsule destruction, or size >5 cm. in diameter
Weigh and measure (three dimensions) the specimen. Ink the external surface.
Examine the external surface and note the presence of attached fat, identify the adrenal vein (underside of flat surface) and note if any vascular tumor invasion.
Serially section the specimen at 2 mm intervals across the short axis.
After sectioning, determine the dimensions of the adrenal gland
Examine the cut surface for nodules and describe them (color, measurements, consistency, degree of circumscription). Note their location (cortex vs. medulla) and whether they appear invasive.
Measure the maximum thickness of the cortex (yellow/tan, normal is 2-3mm) and medulla (dark red/brown grey normal is 4-5mm). Note whether the cortical stripe is straight (normal) or convoluted (hyperplastic).
Describe the uninvolved gland (normal vs. abnormal configuration, color, distinction between cortex and medulla) and attached soft tissue.
Photograph any specimen with: suspected malignancy, tumor >2cm in diameter, bilateral adrenalectomy with asymmetrical glands, adrenal gland weight <5gm or >20gm.
Received without fixative/in formalin, labeled _____ and “_____”, is a __ g specimen consisting of adrenal gland surrounded by fat (__ x __ x __ cm overall, __ x __ x __ cm gland only). There is a __ x __ x __ cm _____ (color, consistency, circumscription) _____ (cortical vs. medullary) nodule which does/does not appear to invade the _____. The uninvolved gland has a _____ (describe) cortex and a _____ (describe) medulla. No lymph nodes are identified in the fat. Representative sections, including 10% of the specimen, are submitted as follows: