# 增生（Hyperplasia）

- 器官 / 系统：肾上腺 / 内分泌系统（adrenal-gland / endocrine-system）
- NTP 数据编号：ntp-0072
- 规范 URL：https://www.labsmart.cn/ntp/adrenal-gland-hyperplasia.html
- 中文图谱总页锚点：https://www.labsmart.cn/ntp-atlas.html#adrenal-gland-hyperplasia
- 原始出处：https://ntp.niehs.nih.gov/atlas/nnl/endocrine-system/adrenal-gland/Hyperplasia
- 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
增生（hyperplasia）定义为细胞数量的局灶性（focal）至弥漫性（diffuse）增加。

## 病变描述（中文）
增生（hyperplasia）定义为细胞数量的局灶性（focal）至弥漫性（diffuse）增加。增生通常为局灶性，但也可能发生弥漫性增生。可累及一侧或双侧肾上腺。在大鼠和小鼠中，皮质增生最常发生于束状带（zona fasciculata）（Figure 1、Figure 2、Figure 3、Figure 4、Figure 5、Figure 6），但网状带（zona reticularis）也可受累。皮质和髓质中的增生灶通常为圆形、边界清楚的区域，直径不一，以皮质细胞数量增多为特征。在皮质中，正常的放射状索状结构通常得以保持。增生灶可边界清晰，也可与邻近正常组织几乎难以察觉地融合；压迫一般不存在或极轻微。与正常皮质细胞相比，增生细胞通常（但并非总是）较小，胞质可呈空泡化和/或染色特性不同（常更嗜碱性）。在髓质中，增生灶常位于肾上腺髓质周边部、皮髓质交界处或其附近（Figure 7、Figure 8），但也可发生于更靠近中央的髓质（Figure 9、Figure 10）。与正常髓质细胞相比，增生细胞通常较小，胞质更嗜碱性（Figure 7、Figure 8、Figure 9、Figure 10）。在皮质和髓质中，均可能罕见核分裂象，但增生细胞通常缺乏细胞异型性特征。皮质增生和髓质增生可为自发性衰老性改变，在大鼠中比小鼠更常见。皮质增生的其他原因包括应激，以及因任何干扰下丘脑-垂体-肾上腺激素轴和/或肾上腺类固醇生成的因子所致的促肾上腺皮质激素（ACTH）水平异常升高。髓质增生也可由实验性遗传修饰、饮食调控和给予各种化学物所致。增生也可能是对变性、萎缩或坏死所致细胞丢失的再生性反应。局灶性皮质增生和髓质增生被视为形态学连续谱中的增殖性病变，可进展为肿瘤（皮质中的腺瘤和癌，髓质中的良性和恶性嗜铬细胞瘤）。将大的局灶性增生与较小的腺瘤或嗜铬细胞瘤相鉴别可能具有挑战性，但与增生灶相比，肿瘤更具压迫性、结构紊乱更明显，并具有一定程度的细胞多形性。皮质增生（细胞数量增多）和皮质肥大（细胞体积增大）常可同时存在于同一腺体甚至同一病灶中。因此，在实际操作中，确定某一给定病变和/或肾上腺中以增生还是肥大为主可能非常困难。

## 诊断与分级建议（NTP 共识，中文）
肾上腺-增生应予以诊断，并赋予严重程度分级以及部位修饰词（即cortex、medulla）和分布修饰词（即局灶性（focal）、弥漫性（diffuse））。当两侧腺体均存在增生时，应添加修饰词“双侧（bilateral）”。当同一肾上腺同一部位（cortex或medulla）同时存在局灶性增生和肿瘤时，仅当病理学家认为二者为独立病变时方可将两者均予以诊断；否则仅诊断肿瘤。当同一病灶中同时存在皮质增生和肥大时，仅应诊断增生，肥大应在病理学描述中予以描述。相关链接：肾上腺-皮质-细胞异型性

## 英文原文 · Comment
Hyperplasia is defined as a focal to diffuse increase in cell number. Hyperplasia is generally focal, though diffuse hyperplasia may occur. One or both adrenal glands can be affected. In both rats and mice, cortical hyperplasia most commonly occurs in the zona fasciculata ( Figure 1 , Figure 2 , Figure 3 , Figure 4 , Figure 5 , and Figure 6 ), though the zona reticularis can also be affected. Hyperplastic foci in the cortex and medulla are generally rounded, circumscribed areas of variable diameter, characterized by increased numbers of cortical cells. In the cortex, the normal radial cord-like architecture is usually maintained. The hyperplastic foci can be well-demarcated or can blend almost imperceptibly with the adjacent normal tissue; compression is generally absent to minimal. Compared with normal cortical cells, hyperplastic cells are usually but not always smaller, with cytoplasm that can be vacuolated and/or tinctorially different (often more basophilic). In the medulla, foci of hyperplasia are often located at the periphery of the adrenal medulla, at or near the corticomedullary junction ( Figure 7 and Figure 8 ), though they can also occur in the more central medulla ( Figure 9 and Figure 10 ). Compared with normal medullary cells, hyperplastic cells are usually smaller with more basophilic cytoplasm ( Figure 7 , Figure 8 , Figure 9 , and Figure 10 ). In both the cortex and medulla, rare mitotic figures may be present, but the hyperplastic cells typically lack features of cellular atypia. Cortical and medullary hyperplasia can be a spontaneous aging change, which occurs more commonly in rats than mice. Other causes of cortical hyperplasia include stress, and abnormally elevated adrenocorticotropic hormone (ACTH) levels due to any factor that perturbs the hypothalamic-pituitary-adrenal hormonal axis and/or adrenal steroidogenesis. Medullary hyperplasia can also result from experimental genetic modifications, dietary manipulations, and administration of various chemicals. Hyperplasia may also be a regenerative response to cell loss from degeneration, atrophy, or necrosis. Focal cortical and medullary hyperplasias are considered proliferative lesions in a morphologic continuum that can progress to neoplasia (adenoma and carcinoma in the cortex and benign and malignant pheochromocytoma in the medulla). Differentiating large focal hyperplasias from smaller adenomas or pheochromocytomas can be challenging, but the neoplasms, compared with hyperplastic foci, are more compressive, exhibit more disorganization, and have some degree of cellular pleomorphism. Cortical hyperplasia (increased cell numbers) and cortical hypertrophy (increased cell size) can often be concurrent lesions in the same gland or even in the same focus. Thus, as a practical matter, determining whether hyperplasia or hypertrophy is predominant in a given lesion and/or adrenal gland can be very difficult.

## 英文原文 · Recommendation
Adrenal gland - Hyperplasia should be diagnosed and assigned a severity grade and site modifier (i.e., cortex, medulla) and distribution modifier (i.e., focal, diffuse). The modifier "bilateral" should be added when hyperplasia is present in both glands. When there is focal hyperplasia and a neoplasm in the same site (cortex or medulla) in the same adrenal gland, both should be diagnosed only if the pathologist feels they are separate lesions; otherwise, only the neoplasm is diagnosed. In cases where cortical hyperplasia and hypertrophy are present in the same lesion, only hyperplasia should be diagnosed, with the hypertrophy described in the pathology narrative. Related Links: Adrenal Gland - Cortex - Cellular Atypia

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