Dept. of Anat., Tokyo Med. and Dent. Univ. (Chief: Prof. T. KIRINO). On Three Cases of the Genuine Accessory Suprarenal Bodies in Man. In the course of studies on the ZUCKERKANDL's paraganglia, by careful microscopic observation, I have found three cases of true accessory suprarenal bodies in paraffin sections of para-aortic tissues of the abdominal aorta. A number of papers have been published on the accessory adrenal glands, according to which, the anomalous bodies found in the retroperitoneal region, genital organs, kidney, etc., always consist only of the tissue equivalent to the adrenal cortex. There is, however, no paper in the literature in which detailed descriptions are given for the genuine accessory adrenal gland i. e a body containing the medullary element of the adrenal gland. Case I is fixed in MULLER's solution while cases II and III in 10% formalin. All of them have been turned into paraffin sections and stained with hematoxylin-eosin. Case I. Observations. This case is found in the para-aortic tissues at the level of the emerging point of the inferior mesenteric artery from the aorta of a one month old girl. As shown in Fig. 1, the nodulous body is encapsulated with a thin, rather compact connective tissue sheath from which very slim connective tissue cords arise and pass radially toward the center of the body. The parenchym of the body is composed of two histologically different parts, the cortical and the central one. In Fig 2 which is a magnified photomicrograph of a part of the same section, cytoarchitecturally three cellular zones are recognizable in the cortical part: a subcapsular zone characterized by the grouping of cells in clusters containing acidophilic granules in the cytoplasm, a wider middle zone in which polygonal, bright and vacuole-rich cells are arranged into cords, and a central zone composed 559
560 K. KUBOTA:
On Three Cases of the Genuine Accessory Suprarenal Bodies in Man. 561 of polygonal cells containing abundant pigment granules in the cytoplasm. Those three zones should correspond to each of the layers in the normal cortex of the adrenal. In the central part no chromaffin cells or ganglionic cells are recognizable. However, judging from the general appearance, it is highly probable that this part of the body represents the medulla of the normal adrenal. Case II. This case is observed in the right coeliac ganglion of a one month old boy (Fig. 3). This specimen is composed of three conglomerations of the accessory gland. Each of these conglomerations is encapsulated with a connective tissue sheath, and they are adjoined to the right coeliac ganglion (Fig. 4). In this case the medullary element is present in a number of cell groups arranged not at the center of the body but across it. From their appearances, we find, however, slightly acidophilic, cuboidal cells arranged in the manner of the glomerulosa and also vacuole-rich cells ar-
562 K. KUBOTA: ranged like the fasciculata of the adrenal cortex. These can be distinguished from large vacuolous cells which are histologically quite similar to
On Three Cases of the Genuine Accessory Suprarenal Bodies in Man. 563 the cells of the chromaffin paraganglia in the same specimen (Fig. 5). These microscopically observable features mentioned above indicate beyond doubt that the cells of the former type are of cortical nature. They should be regarded as the cells of the normal cortex in the adrenal. The cells of the latter type are of medullary nature. In the cortex, a zone which may be regarded as the reticularis has not been recognized. Case III. This case is a small dubious body removed from a man of 65 years of age. It has been suspected of a paraganglionic nodule in the para-aortic tissues near the origin of the inferior mesenteric artery. This nodulous body, which is encapsulated with a thin connective tissue sheath, is composed of two different sorts of cells. One kind of cells occupies the cortical portion, in which acidophilic cells are aggregated in groups like the glomerulosa, fasciculata and reticularis in the cortex of the normal adrenal The other sort of cells is found in the medullary portion. These are basophilic and vacuolous and look like the medullary cells of the medulla of the ordinary adrenal (Fig. 6). Fig. 7 is a higher magnification of a part of the section. Here we can more easily differentiate the cells of the cortical origin from those of the medullary nature. Notice especially the coloration and arrangement of the cells. The difference between the two kinds of cells is quite obvious.
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On Three Cases of the Genuine Accessory Suprarenal Bodies in Man. 565 In addition I would like to emphasize the immigration of small masses of cortical cells into the medulla, as the scattered reticularis tissues in the medulla of the normal adrenal. The cells in the figure are obviously cells of cortical nature and are loaded with pigment granules. Fig. 8 demonstrates the medullary tissue in higher magnification, and Fig. 9 typical, ganglionic cells together with a nerve fiber bundle which indicate to some extent the medullary nature of the tissue.
566 K. KUBOTA. References. (Since there are a great number of papers dealing with the accessory adrenal gland, only significant ones are cited here.) Aichel, O.: Vorlaufige Mitteilung uber die Nebennierenentwicklung der Anz. 17 (1900). -Bachmann, R.: Die Nebenniere. Handbuch der mikroskopischen Anatomie des Menschen. 5. Tl. Berlin, Gottingen u. Heidelberg, 1954. - Eggeling, H.: Eine Nebenniere im Lig. hepatoduodenale. Anat. Anz. 21 (1902). -Iwanoff, G.: Beitrag zur Anatomie und Histologie der Interrenalkorper des Menschen. Z. Anat. 82 (1927). -Klebs, E.: Die Veranderungen der Nebennieren. Handbuch der pathologischen Anatomie, Bd. 1. Berlin, 1868. -May, R.: Beitrage zur pathologischen Anatomie der Nebennieren. Virch. Arch. 108 (1887). -Watzka, M.: Die Paraganglien. Handbuch der mikroskopischen Anatomie des Menschen. 4. Tl. Berlin, 1943.