Prognostic Factors in Adrenal Cortical Tumors: A Mathematical Analysis of Clinical and Morphologic Data

Hough, Aubrey J.; Hollifield, John W.; Page, David L.; Hartmann, William H.

doi:10.1093/ajcp/72.3.390

Cited by 296 publications

(158 citation statements)

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“…The possible adenoma-carcinoma sequence is reflected by the problems in the differentiation between adenoma and carcinoma of the adrenal cortex (Hough et al, 1979;Weiss, 1984;van Slooten et al, 1985). Malignancy of an adrenal tumour cannot be demonstrated by a single morphological variable.…”

Section: Discussionmentioning

confidence: 99%

Nuclear DNA content and morphological characteristics in the prognosis of adrenocortical carcinoma

Haak

Cornelisse²,

Hermans³

et al. 1993

Br J Cancer

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Summary Prognostic factors are needed for the management of patients with adrenocortical tumours. For this reason, the nuclear DNA content of patients with adrenocortical tumours was analysed by flow cytometry. The relationships between nuclear DNA content, histological indices, and clinical parameters were studied. DNA ploidy could be evaluated in 54 carcinoma and 31 adenoma patients. Twenty-one (68%) of the adenomas, and 6 (11%) of the carcinomas, were DNA diploid. Hypo/Hyperdiploidy was found in 5 (16%) of the adenomas, and 15 (28%) of the carcinomas. The remaining patients had a DNA index above 1.40. A shorter survival was found in patients with diploid carcinomas (P <0.05). A longer disease-free survival was seen in patients with hypo/hyperdiploid carcinomas (P <0.05). Nuclear DNA content was not related to the histological index, nor to clinical parameters. We conclude that nuclear DNA content is related to (diseasefree) survival of patients with adrenocortical carcinomas. An adenoma-carcinoma sequence may be present in the adrenal cortex. In adrenocortical tumours ploidy evolution appears to be different than that observed in other solid tumours.

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Section: Discussionmentioning

confidence: 99%

Nuclear DNA content and morphological characteristics in the prognosis of adrenocortical carcinoma

Haak

Cornelisse²,

Hermans³

et al. 1993

Br J Cancer

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“…In fact, at variance with other endocrine tumors (i.e., follicular tumors of the thyroid), the pathological diagnosis of "carcinoma" does not rely on clear-cut morphological parameters but mostly on a combination of multiple features suggestive, but not pathognomonic per se, of malignancy [22]. Therefore, in the last decades, variable combinations of such parameters in different scoring systems have been proposed in the literature [21,43] being the scoring method proposed by Weiss in 1984 [48] with subsequent modifications [49] and revisions [2] by far the most widely employed.…”

Section: Introductionmentioning

confidence: 99%

The Weiss Score and Beyond—Histopathology for Adrenocortical Carcinoma

et al. 2011

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The pathological diagnosis of adrenocortical carcinoma (ACC) is still challenging for its rarity and the presence of special variants (pediatric, oncocytic, myxoid, and sarcomatoid). It is based on the recognition at light microscopy of at least three among nine morphological parameters, according to the Weiss scoring system, which has been introduced 27 years ago and nowadays is the most widely employed. Nevertheless, the diagnostic performance of this system is very high but does not reach a sensitivity and specificity of 100%, its diagnostic applicability is potentially low among non-expert pathologists, and a group of borderline cases with only one or two criteria exist of uncertain behavior. Moreover, it is scarcely reproducible in the ACC morphological variants. In fact, specifically for the pure oncocytic neoplasms that seem to have a better prognosis in comparison to the conventional ACCs, a modified system (the Lin-Weiss-Bisceglia) has been proposed. With the aim to simplify the ACC diagnosis, 2 years ago, 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. Following this algorithm, in the presence of reticulin alterations, malignancy is further defined through the identification of at least one of the following parameters: necrosis, high mitotic rate, and venous invasion. As a complement to the morphological approach, some immunohistochemical markers (such as steroidogenic factor 1) have been proposed as diagnostic and prognostic adjuncts but still lack wide clinical validation.

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“…A combination of clinical and histopathoplogical parameters were used by Hough et al to distinguish cortical adenoma from carcinoma. 4 Weiss proposed a system for identifying malignancy in cortical tumours based on nine distinct histopathological criteria. Van Slooten, et al formulated a histopathologic index basing on seven histopathological parameters to distinguish benign from malignant tumours.…”

Section: Adenoma Versus Carcinomamentioning

confidence: 99%

Cracking the diagnostic puzzle of tumours of adrenal cortex: a histopathological study

et al. 2016

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Prognostic Factors in Adrenal Cortical Tumors: A Mathematical Analysis of Clinical and Morphologic Data

Cited by 296 publications

References 0 publications

Nuclear DNA content and morphological characteristics in the prognosis of adrenocortical carcinoma

Nuclear DNA content and morphological characteristics in the prognosis of adrenocortical carcinoma

The Weiss Score and Beyond—Histopathology for Adrenocortical Carcinoma

Cracking the diagnostic puzzle of tumours of adrenal cortex: a histopathological study

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