Diagnosis of adrenocortical tumors by reticulin algorithm

Abstract

Aims:To apply reticulin algorithm (RA) to the diagnosis of adrenocortical tumors on adrenalectomy specimens and compare its efficacy to the modified Weiss criteria or Lin–Weiss–Bisceglia (LWB) criteria for oncocytic variant.Materials and Methods:Adrenocortical tumors (ACTs) diagnosed on resected specimens including the variants during January 2010–June 2016 were retrieved from the pathology records. The demographic and clinical data were obtained from medical records. The functional status of the tumor was noted based on clinical and biochemical evaluation. The location, size, and gross appearance of the tumor were noted. The corresponding hematoxylin and eosin-stained slides were independently assessed by two pathologists applying modified Weiss criteria and LWB criteria for the oncocytic variant as applicable. Reticulin stain was performed on representative sections in all cases. All the tumors were classified according to RA, and the diagnoses made by each system were correlated.Results:There were 15 ACTs in the study period. There were two adenomas including one oncocytoma which showed Weiss score (WS) of 2 and intact reticulin framework. There were 13 adrenal cortical carcinomas including two oncocytic variants with WS ranging from 4 to 7. There was disruption of reticulin and thick, irregular reticulin fibers in all tumors, irrespective of the histology. It correlated with modified Weiss and LWB criteria.Conclusions:The RA was simple, easy to apply, and correlated well with modified Weiss criteria in the diagnosis of ACTs including the oncocytic variant.

The Role of Immunohistochemical Markers for the Diagnosis and Prognosis of Adrenocortical Neoplasms

“…However, only the pathological p53 nuclear protein expression was found to have a prognostic role since it was significantly correlated with mortality rate, PFS and metastatic status. The reticulin algorithm defines malignancy through an altered reticulin framework associated with one of the three following parameters: necrosis, high mitotic rate, and vascular invasion for the diagnosis of ACCs [ 18 , 19 , 32 , 33 ]. The “reticulin” diagnostic algorithm has been proposed, based on the observation that the tumoral reticulin framework (highlighted by reticulin silver-based histochemical staining) is consistently disrupted in malignant cases but only in a small subset of benign cases.…”

“…The “reticulin” diagnostic algorithm has been proposed, based on the observation that the tumoral reticulin framework (highlighted by reticulin silver-based histochemical staining) is consistently disrupted in malignant cases but only in a small subset of benign cases. Several case series on ACCs have confirmed the usefulness of the reticulin algorithm for the distinction of ACCs from ACAs [ 2 , 19 , 32 , 33 , 34 ], although without showing any correlation with prognosis in these patients [ 6 , 35 ]. Our series confirmed the quantitative loss of reticulin framework as a significant finding, distinguishing ACCs and ACAs, showing also a significant positive correlation with Weiss score without being significantly associated with prognosis.…”

Overview of the 2022 WHO Classification of Adrenal Cortical Tumors

“…A diagnosis of ACC is rendered when an altered reticulin network (see Question 10 ) (Fig. 27 ), as demonstrated by the Gordon Sweet silver histochemical stain, is seen in association with one of the following parameters: (i) the presence of mitotic rate > 5 mitoses per 10 mm 2 (50 high-power fields), (ii) tumor necrosis, or (iii) vascular invasion (angioinvasion) [ 120 , 130 , 131 , 134 ].…”

Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging

“…The first case of oncocytic ACC was confirmed in 1991 by electron microscopy showing the closely packed mitochondria in an ACC from a 56-year-old man [ 112 ]. Up to the year 2020, there were 56 cases of oncocytic ACC in the adrenal gland with documented features in the English literature [ 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 ]. Apart from these cases, a giant ectopic oncocytic ACC (280 mm in greatest dimension; 2250 g in weight) have been reported in a 26-year-old Hispanic woman in tissue around the left adrenal gland and kidney {Wadhwani 33,281,927} [ 138 ].…”