Figure 2.

Classic Cushing Syndrome. A through F, Patient 1; G through J, Patient 10. A, At age 17 years, the patient’s plump face was covered with small pigmented spots. B, At age 65 years, the face had lost its fullness and the facial pigmentation was less obvious. C, Cut surface of left adrenal gland at autopsy showed several dark micronodules (arrows). D, The left adrenal gland featured several micronodules (asterisks) and loss of normal cortical zonation. The capsule was intact. There was no extracapsular extension (hematoxylin-eosin, original magnification ×20). E, A cortical nodule had large and huge eosinophilic cells, many with lipochrome (arrows), and there was an exceptional cell with elongated crystal type spaces (center) (hematoxylin-eosin, original magnification ×400). F, Synaptophysin staining. Upper, Two positive areas were seen; 1 was ovoid (asterisk) (original magnification ×100). Lower, Heavily stained round paranuclear “bodies” (arrows) were seen along with cell membrane and cytoplasmic staining (original magnification ×400). G, Carney complex mucosal and skin lesions (patient 10). Upper, Mucocutaneous pigmentation. Middle, Lacrimal caruncular pigmentation. Lower, Cutaneous auricular nodule (myxoma). H, Cut surfaces of the left adrenal gland showed variably-sized pigmented micronodules and oval elongated zones (arrows) and a 1.7-cm oval darkly pigmented lesion (myelolipoma) (asterisk) attached to the gland. I, Bottom left slice of adrenal in H showed an epicapsular mass of cortical cells with some fat (arrows) (hematoxylin-eosin, original magnification ×1). J, The gland had multiple micronodules staining strongly for synaptophysin (arrows). The myelolipoma was weakly stained for synaptophysin (original magnification ×1).