Exploration of KCNJ5 Somatic Mutation and CYP11B1/CYP11B2 Staining in Multiple Nodules in Primary Aldosteronism

Figures

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  FIGURE 1. Hematoxylin and eosin (H&E) and immunohistochemical staining of CYP11B1 and CYP11B2 in case 4. (A) Innumerable nodules with intensive hyperplasia of the gland with 3 well-demarcated nodules by 0.4, 0.5, and 0.6 cm in diameter independently (marked by red circles). Irregular zone with CYP11B1 (C) weak staining and CYP11B2 (D) strong expression (marked by green rectangles). Irregular zone with CYP11B2 strong expression harbored KCNJ5 mutation of 503 (168) T > G (B).

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  FIGURE 2. Hematoxylin and eosin (H&E) and immunohistochemical staining of CYP11B1 and CYP11B2 in case 13. Two well-demarcated nodules in adrenal (A, up and down); two nodules both composed of acidophilic cells and clear cells (B, 400× magnification for nodules respectively, up and down). Weak expression of CYP11B1 (C, 400× magnification for insert), completely negative staining of CYP11B2 in both nodules, several APCCs detected in the adrenal cortex (D, indicated by red arrows, 200× magnification for insert).

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  FIGURE 3. Hematoxylin and eosin (H&E) and immunohistochemical staining of CYP11B1 and CYP11B2 in cases 17, 6, and 18. In case 17, one obscure nodular mainly with acidophilic cells (A, left), the other one with a mixture of acidophilic cells and clear cells (A, right, marked by the red circle). One-third of the nodules are positive for CYP11B2 (C, marked by the red circle) and weak positive for CYP11B1, moderate expression for CYP11B1 in the rest zone of the nodule (B, marked by red circle). In case 6, one of 4 clear cell nodules (0.8 cm in diameter) (D, marked by the red circle), focal CYP11B2-positive and CYP11B1-negative area by 4 mm × 3 mm (E,F), moderate expression of CYP11B1 in the rest of nodule (E). In case 18, 2 clear cell-dominant nodules (G, left and right), the rare annular-pattern of CYP11B2 expression on the periphery of the smaller nodule (I, indicated by red arrows, 200 × magnification for insert), moderate expression of CYP11B1 (H, right), strong expression of CYP11B2 (I, left), and slight expression of CYP11B1 (H, left) in the bigger one.