Studio Istologico Ed Istochimico Dei Surreni e Delle Ovaie in Pazienti Portatrici Di Carcinoma Mammario (*)

Abstract

98 women with advanced breast cancer underwent adrenalectomy, 88 also ovariectomy; in 56 adrenalectomy was performed in two times.

1) The adrenal weight shows marked variations from case to case.

2) Normal glomerulosa (35,5 %), hypertrophic fasciculata (55 %), and hypertrophic (43 %) or normal (43 %) reticularis are more frequent in the first removed adrenals. Reticularis hypertrophy is more marked in women ovariectomized many years before. The histochemical examination, carried out in 30 cases, shows a prevalence of acid fats on neutral ones and a phospholipids and cholesterol decrease.

3) The adrenals removed by contralateral adrenalectomy show initial hypotrophy followed by hypertrophy of glomerulosa, hypertrophy of fasciculata (70%), initial hypertrophy followed by hypotrophy of reticularis. In the second adrenal a marked decrease of lipids is observed (85 %), especially when a short period of time was elapsed between first and second operation; cholesterol is always decreased.

4) It is interesting to notice the scanty amount of mucopolysaccharides, the frequent (75 %) occurrence of foamy cytoplasms in fasciculata, the presence (in the 39 per cent of the cases) of big nuclei in the same zone.

5) Ovaries show frequently (75 %) cortical hyperplasia, which is very marked in the 50 per cent of the cases.

6) Adrenal metastases have been found in the 35,7 per cent (21,7 % bilaterally), ovarian ones in the 26,1 per cent (15,9 % bilaterally).

7) 52 patients improved after endocrino-surgical treatment, 32 showed no clinical modifications, in 14 a follow-up was not possible owing to various reasons. The biovaro-monoadrenalectomy, followed by controlateral adrenalectomy, gave the best results. The patient's age has no prognostic value.

8) As regards functional meaning of the microscopic features of adrenals and ovaries some hypotheses are advanced in order to explain some histochemical pictures.

9) Hormonal dosages in urine and adrenal homogenate show a higher output of estrogens in the improved cases (67 γ/24 h in 9 improved patiens; 20 γ/24 h in 7 unimproved ones), and a probable correlation between thickness of reticularis and sex steroids amount of adrenals.