TUMORS 337 



hyperplasia or as circumscribed nodules ranging in size from 

 microscopic islets of tissue to the size of a hen's egg and are 

 incidental findings in about a third of all autopsies. They may 

 be found in the medulla, in the cortex, or projecting from the 

 surface of the gland, and are difficult to distinguish from acces- 

 sory interrenal bodies which in a sense they really are. 



Microscopically these bodies consist of columns of cells 

 similar to that of the fascicular zone, but at times an arrange- 

 ment like that of the glomerulosa characterizes the peripheral 

 layers of cells. 335 



Adenomata. The cortical adenomata resemble superficially 

 the nodular hyperplasia described in the preceding section. 

 They differ from the latter by their atypical cell structure and 

 their malignant tendencies. The cortical adenomata form 

 yellowish or reddish masses well circumscribed from the rest 

 of the cortex. They often deform or destroy the gland. 335 

 Although frequently manifesting all the signs of normal func- 

 tional activity, the adenomata at times are found in varying 

 stages of lipoidal degeneration. 



Clinically the cortical adenomata produce no demonstrable 

 symptoms as might be anticipated from the innocuous effects 

 of injections of large amounts of the cortical hormone. Never- 

 theless, the larger growths appear to be definitely neoplastic. 254 



Carcinomata. The adenocarcinoma of the adrenal resemble 

 the adenomata from which they probably originate. Unlike 

 the adenomata they contain atypical areas of malignant char- 

 acter and metastasize readily to other organs. In the so-called 

 undifferentiated carcinoma of the adrenals one finds large 

 granular fatty cells arranged around the blood vessels, or 

 rounded polyhedral cells free of fat and glycogen. These also 

 metastasize early and infiltrate the surrounding tissues. 215230 - 335 



Malignant tumors of the interrenal tissue are exceedingly 

 rare. Many of the cases described in the literature as carci- 

 noma of the cortex are neoplasms of the androgenic tissue 

 which give rise to the adreno-genital syndrome to be described 



