Definition: Adrenal cytomegaly is characterized by the presence of large polyhedral cells with eosinophilic granular cytoplasm and enlarged nuclei in the adrenal cortex. Adrenal cytomegaly is found in 0.8% pediatric autopsies.
Adrenal cytomegaly is relatively common finding within fetal cortex in newborns, particularly premature infants (3-7%) or infants with Rh incompatibility.
Adrenal cytomegaly may be associated with Beckwith-Wiedemann syndrome
Focal adrenal cytomegaly can be observed in normal adults (3778124)
Macroscopy
hyperplastic adrenal glands
Microscopy
numerous markedly enlarged (up to 150 microns) and bizarre polyhedral cells with eosinophilic granular cytoplasm and large hyperchromatic nuclei with pseudoinclusions in adrenal cortex.
large polyhedral cells in the adrenal cortex
- eosinophilic granular cytoplasm
- enlarged nuclei
false intranuclear inclusions (6264884)
no/rare mitotic figures
Electron microscopy
nuclear inclusions composed of the invaginated portion of the cytoplasm surrounded by double membrane and contained numerous organelles. (6264884)
Etiology (Exemples)
Beckwith-Wiedemann syndrome (1849635, 2845376)
isolated (3778124, 3838445)
- in adults (3778124)
Associations
diaphragmatic hernia (10879233)
premature infants (3-7%)
infants with Rh incompatibility
Case records
Differential diagnosis
adrenal CMV infection
- usually infants
- basophilic cytoplasm
- large intranuclear inclusion surrounded by a clear halo
References
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Birdwell TR, Dimmette RM. Cytomegaly of the adrenal gland. An interesting finding: report of three cases. Am J Clin Pathol. 1967 May;47(5):585–587.