# 皮质被膜下增生（Cortex Hyperplasia Subcapsular）

- 器官 / 系统：肾上腺 / 内分泌系统（adrenal-gland / endocrine-system）
- NTP 数据编号：ntp-0082
- 规范 URL：https://www.labsmart.cn/ntp/adrenal-gland-cortex-hyperplasia-subcapsular.html
- 中文图谱总页锚点：https://www.labsmart.cn/ntp-atlas.html#adrenal-gland-cortex-hyperplasia-subcapsular
- 原始出处：https://ntp.niehs.nih.gov/atlas/nnl/endocrine-system/adrenal-gland/Cortex-HyperplasiaSubcapsular
- 授权：美国联邦政府作品，公有领域；引用请标注 NTP Nonneoplastic Lesion Atlas
- 适用说明：仅供科研使用，不用于临床诊断

## 一句话结论
肾上腺皮质被膜下增生（Adrenal cortical subcapsular hyperplasia）（Figure 1、Figure 2、Figure 3、Figure 4、Figure 5、Figure 6、Figure 7、Figure 8）仅见于小鼠，未见於大鼠。

## 病变描述（中文）
肾上腺皮质被膜下增生（Adrenal cortical subcapsular hyperplasia）（Figure 1、Figure 2、Figure 3、Figure 4、Figure 5、Figure 6、Figure 7、Figure 8）仅见于小鼠，未见於大鼠。这是大多数品系老年小鼠中非常常见的自发性病变，因此发生率和严重程度通常随年龄增长而增加。该病变在雌性小鼠中也远比雄性小鼠常见，且通常更为广泛。在某些小鼠品系中，去势可诱导被膜下细胞增殖（增生和肿瘤形成）。该变化的特征为肾上腺皮质被膜下细胞数量增多，这些细胞通常被认为是多能干细胞/祖细胞，负责补充内层皮质区衰老的细胞。在适当激素刺激下，被膜下细胞可转分化为类似性腺间质细胞的性类固醇生成细胞。被膜下增生病灶中可能存在两种形态不同的被膜下细胞：细长的梭形或纺锤形A型细胞（Figure 5），核呈椭圆形，胞质少而嗜碱性；以及较大的圆形或多边形B型细胞（Figure 6），胞质更丰富、淡染至透明，核圆形。早期增生病灶（Figure 1、Figure 2）由小的、常呈线状排列的病灶组成，主要由梭形样A型细胞构成。细胞簇最初位于紧邻被膜的球状带（Figure 1、Figure 2），但随着细胞聚集因增殖而增大，它们向心性延伸，呈窄至宽的楔形插入下方束状带细胞索之间，并呈与肾上腺被膜平行的线状片层（Figure 1、Figure 2、Figure 3）。随着增生病灶增大，B型细胞出现，并随病变进一步进展，多边形B型细胞与梭形A型细胞的比例通常增加（Figure 3、Figure 4）。同一肾上腺中的多个病灶可融合，形成被膜下几乎连续的增生细胞带（Figure 7）。非常大的病灶（Figure 8）通常几乎完全由多边形B型细胞组成，细长的A型细胞很少，并可表现出一定程度的压迫和膨胀。局灶性（focal）被膜下增生被认为是一种形态学连续谱中的增殖性病变，可进展为腺瘤，罕见进展为癌。被膜下腺瘤也由分化良好的“梭形”和“多边形”细胞以不同比例混合组成，因此区分大的局灶性增生与较小的腺瘤可能具有挑战性。与增生病灶相比，腺瘤更大、结节性更明确、明显压迫肾上腺实质，并且由于显著的膨胀性增殖，甚至可能明显突出于被膜表面。

## 诊断与分级建议（NTP 共识，中文）
肾上腺皮质被膜下增生应予以诊断并赋予严重程度分级。

## 英文原文 · Comment
Adrenal cortical subcapsular hyperplasia ( Figure 1 , Figure 2 , Figure 3 , Figure 4 , Figure 5 , Figure 6 , Figure 7 , and Figure 8 ) has been seen only in mice, and not in rats. It is a very common spontaneous finding in older mice of most strains, so incidences and severity generally increase with age. The lesion is also much more common and typically more extensive in female than in male mice. Subcapsular cell proliferation (hyperplasia and neoplasia) can be induced in certain mouse strains by gonadectomy. This change is characterized by increased numbers of adrenal cortical subcapsular cells, generally considered to be the multipotential stem/progenitor cells that replenish senescent cells in the inner cortical zones. Under appropriate hormonal stimulation, the subcapsular cells can transdifferentiate into sex-steroid–producing cells resembling stromal gonadal cells. Two morphologically different types of subcapsular cells may be present in subcapsular hyperplastic lesions: elongated, spindle or fusiform type A cells ( Figure 5 ) with elliptical nuclei and scanty basophilic cytoplasm, and larger, round or polygonal type B cells ( Figure 6 ) with more abundant, pale to clear cytoplasm and round nuclei. Early hyperplastic lesions ( Figure 1 and Figure 2 ) consist of small, often linear foci composed primarily of the spindle-like type A cells. The cell clusters are located initially in the zona glomerulosa adjacent to the capsule ( Figure 1 and Figure 2 ), but as the cell aggregates enlarge due to proliferation, they extend centripetally as narrow to broad wedges intercalated between the underlying zona fasciculata cell cords and in linear sheets parallel to the adrenal capsule ( Figure 1 , Figure 2 , and Figure 3 ). As the hyperplastic lesions enlarge, type B cells appear, and with further progression the ratio of polygonal type B cells to spindle type A cells usually increases ( Figure 3 and Figure 4 ). Multiple foci in a given adrenal gland may coalesce to form an almost continuous band of hyperplastic cells subjacent to the capsule ( Figure 7 ). Very large foci ( Figure 8 ) are often composed almost entirely of polygonal type B cells, with few elongated type A cells, and can exhibit some degree of compression and expansion. Focal subcapsular hyperplasia is considered a proliferative lesion in a morphologic continuum that can progress to adenoma and, rarely, to carcinoma. Subcapsular adenomas are also composed of variable mixtures of well-differentiated "spindle" and "polygonal" cells, so differentiating large focal hyperplasias from smaller adenomas can be challenging. Compared with hyperplastic foci, adenomas are larger, are more discretely nodular, clearly compress the adrenal parenchyma, and may even bulge prominently above the capsular surface due to pronounced expansile proliferation.

## 英文原文 · Recommendation
Adrenal cortical subcapsular hyperplasia should be diagnosed and assigned a severity grade.

## 配图
- https://www.labsmart.cn/ntp-atlas-images/ntp_0224.jpg
- https://www.labsmart.cn/ntp-atlas-images/ntp_0223.jpg

整理：北京天融慧通科技有限责任公司（LabSmart）｜ https://www.labsmart.cn