Adrenal Gland, Cortex - Hyperplasia, Subcapsular







comment:
Adrenal cortical subcapsular hyperplasia ( Figure 1







This change is characterized by increased numbers of adrenal cortical subcapsular cells, generally considered to be the multipotential stem/progenitor cells that replenish senescent cells in the inner cortical zones. Under appropriate hormonal stimulation, the subcapsular cells can transdifferentiate into sex-steroid–producing cells resembling stromal gonadal cells. Two morphologically different types of subcapsular cells may be present in subcapsular hyperplastic lesions: elongated, spindle or fusiform type A cells ( Figure 5













Focal subcapsular hyperplasia is considered a proliferative lesion in a morphologic continuum that can progress to adenoma and, rarely, to carcinoma. Subcapsular adenomas are also composed of variable mixtures of well-differentiated "spindle" and "polygonal" cells, so differentiating large focal hyperplasias from smaller adenomas can be challenging. Compared with hyperplastic foci, adenomas are larger, are more discretely nodular, clearly compress the adrenal parenchyma, and may even bulge prominently above the capsular surface due to pronounced expansile proliferation.
recommendation:
Adrenal cortical subcapsular hyperplasia should be diagnosed and assigned a severity grade.references:
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