PMC6309372_01
Left Adrenal (Patient 3). A, An intermediate-power microscopic view showed multiple, intra-adrenal cortical nodules (black asterisks) and circumscribed and uncircumscribed zones of extracapsular cortical cells (white asterisks). B, A circumscribed cortical nodule composed of eosinophilic cells with uniform nuclei was located between the atrophic cortex (above) and the medulla (below). C, A break in the capsule permitted extracapsular extrusion (circumscribed) of cortical cells (Masson trichrome) (indicated by the upper white asterisk in panel A). D, Higher-power magnification of the area indicated by the lower white asterisk in panel A showed capsular collagen fibers (stained blue) separated by cortical cells. The cells extended among the epiadrenal adipocytes, forming a circumscribed, bulbous minimass (Masson trichrome).
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F2
The capsular collagen fibers were separated by groups of cortical cells and were hidden among the cortical cells, masked by the eosinophilia of the permeating intracapsular cortical cells, and easily overlooked with hematoxylin-eosin staining but readily identified with Masson trichrome staining (Figure 2D).
Left Adrenal (Patient 3). A, The cortical adenoma featured a sheet of eosinophilic and clear, vacuolated cortical cells surrounded by a fibrous pseudocapsule that separated it from the attached gland, which had cortical micronodules. Small foci of extracapsular cortical cells were present (arrows). B, beta-Catenin stained the cell membrane, cytoplasm, and nuclei of the tumor in panel A.
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F3
CD56 and Bcatenin (cytoplasm, membrane and nuclei with the latter (Figure 3B). Certain lobules, but not necessarily the same ones, stained for vimentin, synaptophysin and inhibin-A.
Multiple Cortical Micronodules in Left Adrenal (Patient 2). The micronodules were positive for synaptophysin (B), inhibin-A (C), and melan A (D); variably positive for CD56 (E); and variably negative for vimentin (asterisks) (A). The extracortical nodule (bottom, A-F) showed zonal positive and negative staining. The atrophic cortex stained with vimentin (A), melan A (D), CD56 (E), and beta-catenin (F) antibodies.
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F4
The cortical micronodules in patients 1, 2, and 3 stained with synaptophysin, inhibin-A, melan A, Ki-67 (moderate number of stained nuclei), and beta-catenin antisera and did not stain for vimentin (2 of the 3 patients) (Figure 4). Some nodules were partly positive and partly negative for the same antiserum (Figure 4A).
Micronodules in Left Adrenal (Patient 5). The micronodules (A) were shown to be extracapsular with Masson trichrome staining (B). The micronodules were variably stained with vimentin, synaptophysin, inhibinA, melan A, CD56, and beta-catenin (C, D, E, F, G, and H). The hyperplastic cortex stained strongly but variably with melan A, CD56, and beta-catenin (F, G, and H), and scattered cells were stained by synaptophysin and inhibin-A antisera (D and E). M indicates medulla.
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F5
The staining results for the intracapsular and extracapsular cortical cells were similar to those for the hyperplastic cortex, with the exception of the beta-catenin nuclear staining (Figure 5).