[A rainbow coupling human pathology and endocrinology, with emphasis on the adrenal glands]

Recent progress in research methodology particularly of immunocytochemistry has made the viaduct of human pathology through endocrinology a wide bridge. Immunohistochemical demonstration of enzymes working in corticosteroidogenesis is useful for the interpretation of histological findings. Cytochrome P-450C21 was demonstrated in three adrenocortical layers particularly evident in the glomerulosa and reticularis. The reactivity was intensive in hypertrophied cells in focal hyperplasia of autopsy series and adenomas in patients with hyperadrenocorticism. The distribution of extra-adrenal steroid 21-hydroxylase was revealed by immunohistochemistry at the distal and collecting tubules of the kidney, excretory ducts of the pancreas and salivary glands, mammary ducts and ductules and secretory portion of the sweat gland in man. It was postulated that in these target tissues of the mineralocorticoid action considerable amounts of DOC would be produced from plasma progesterone by the extra-adrenal 21-hydroxylase. Histopathological diagnosis of malignancy in adrenal tumors has been extremely difficult. Therefore, follow-up informations of metastasis and/or recurrence and gross findings including the tumor weight have been evaluated as the evidence of malignancy. In adrenocortical tumors plasma steroid patterns and in vitro steroid production which were appreciated in the clinical endocrinology, were corroborated by gross and microscopical findings. Immunohistochemical lectin bindings revealed that only RCA (Ricinus communis agglutinin) might be useful for the marker of adrenocortical malignancies. For establishing histological criteria of malignant pheochromocytomas, 25 adrenal and extra-adrenal tumors associated with metastases were examined. Localized or diffuse proliferation of small-sized cells, fusiform or round in shape, frequently associated with mitotic figures and foci of necrosis was of common feature. Immunoreactive peptide hormones were less compared with benign pheochromocytomas.