[Cushing syndrome--a pathologic analysis based on 216 resected specimens]

To study the morphological features of adrenal cortex in Cushing's syndrome and the correlation of morphological changes with clinical manifestations.

216 cases of Cushing's syndrome were collected. Among these there were 160 cases of adrenal hyperplasia, 50 cases of adenoma and 6 cases of adenocarcinoma of adrenal cortex. The morphometric method was used to measure the thickness of adrenal cortex microscopically. The weight of the resected specimens were carefully recorded and correlated with clinical laboratory findings and clinical manifestations.

In adrenal cortex hyperplasia, the thickness and weight of the adrenal cortex increased gradually in the order of mild, moderate and severe hyperplasia. The hyperplasia and hypertrophy of the compact cell are very common in these specimens. The frequency of compact cell predominant cases was also increased in severe hyperplasia. The weight and size of the tumor differed significantly between adenoma and adenocarcinoma of the adrenal cortex.

In Cushing's syndrome, adrenal cortex hyperplasia is the most common. The grade of hyperplasia was well correlated with clinical laboratory findings. Increase of frequency of compact cell predominance is important morphological feature of hyperplasia of adrenal cortex. Adenoma should be considered when atrophy of adjacent cortex is present. The tumor size and weight as well as mitosis are important parameters in differential diagnosis between adenoma and adenocarcinoma of the adrenal cortex, but the infiltration of capsule and blood vessels and/or metastasis still remain the gold criteria for diagnosis of adrenal adenocarcinoma.