• Most common lesions are adenomas (yellow), pheochromocytoma (red), and cortical hyperplasia. Malignancy should be suspected if multiple nodules, any tumor with necrosis, adrenal capsule destruction, or size >5 cm. in diameter
• Weigh and measure (three dimensions) the specimen. Ink the external surface.
• Examine the external surface and note the presence of attached fat, identify the adrenal vein (underside of flat surface) and note if any vascular tumor invasion.
• Serially section the specimen at 2 mm intervals across the short axis.
• After sectioning, determine the dimensions of the adrenal gland
• Examine the cut surface for nodules and describe them (color, measurements, consistency, degree of circumscription).  Note their location (cortex vs. medulla) and whether they appear invasive.
• Measure the maximum thickness of the cortex (yellow/tan, normal is 2-3mm) and medulla (dark red/brown grey normal is 4-5mm). Note whether the cortical stripe is straight (normal) or convoluted (hyperplastic).
• Describe the uninvolved gland (normal vs. abnormal configuration, color, distinction between cortex and medulla) and attached soft tissue.
• Photograph any specimen with: suspected malignancy, tumor >2cm in diameter, bilateral adrenalectomy with asymmetrical glands, adrenal gland weight <5gm or >20gm.

• Small cortical nodule:  entire nodule up to five blocks (whichever is less).
• Mass greater than 5 cm:  one block per cm of mass, including capsule.
• Submit at least one block of uninvolved adrenal gland.
• Any extraneous organ (e.g. liver or kidney).

Internal use only

Received without fixative/in formalin, labeled _____ and “_____”, is a __ g specimen consisting of adrenal gland surrounded by fat (__ x __ x __ cm overall, __ x __ x __ cm gland only).  There is a __ x __ x __ cm _____ (color, consistency, circumscription) _____ (cortical vs. medullary) nodule which does/does not appear to invade the _____.  The uninvolved gland has a _____ (describe) cortex and a _____ (describe) medulla.  No lymph nodes are identified in the fat.  Representative sections, including 10% of the specimen, are submitted as follows:

#__ & #__ = representative nodule

#__ = uninvolved adrenal gland

#__= periadrenal fat

__ blocks, __ H&E