Malignant pheochromocytoma: new malignancy criteria
- First Online:
- 968 Downloads
The pathological diagnosis of malignancy in pheochromocytomas remains a controversial issue. According to the WHO, malignancy is defined in the presence of metastasis. Multiparameter scoring systems such as PASS (Pheochromocytoma of Adrenal gland Scaled Score) have been used but remain controversial. The aim of this study was to search for new immunohistologic elements allowing determination of pheochromocytoma malignancy.
Among 53 patients operated for pheochromocytoma between 1993 and 2009, we selected pheochromocytomas with proven metastasis, seven cases in group 1 (G1) and paired two others groups: group 2 (G2), patients who had “benign” pheochromocytoma with PASS ≥4 and group 3 (G3), patients who had “benign” pheochromocytoma with PASS <4. We retrospectively analysed PASS criteria, size, weight, tumour necrosis, Ki-67 and pS100 staining.
The size and weight of the lesion were directly and significantly correlated to malignancy in all three groups: respectively 9.7 cm and 292.0 g (G1), 6.2 cm and 83.8 g (G2) and 3.8 cm and 37.1 g (G3) (p < 0.005 for both). Tumour necrosis (TN) was present in all G1 (p < 0.005) and respectively at 0% and 37.5% in G2 and G3. Ki-67 is directly correlated to presence of TN (p < 0.005) and malignancy (G1 14.1%, G2 1.8%, G3 2.6%; p < 0.001). All G1 had a Ki-67 index >4%, although one G3 presented an 11% Ki-67 index. There was an inverse statistically significant correlation between the three groups in staining using pS100 (p < 0.01).
Size and weight of the pheochromocytoma are directly related to PASS and malignancy. The presence of tumour necrosis, Ki-67 index >4% and pS100 absence impose a close histopathological evaluation and follow-up with regard to cases presenting a high risk of malignancy/recurrence.
KeywordsPheochromocytoma Malignant pheochromocytoma PASS Ki-67 index pS100
- 3.Thompson LD, Young WF, Kawashima A, Komminoth P, Tischler AS (2004) Malignant adrenal phaeochromocytoma. In: DeLellis RA, Lloyd RV, Heitz PU, Eng C (eds) WHO classification of tumours: pathology and genetics—tumours of endocrine organs. IARC, Lyon, pp 147–150Google Scholar
- 4.Lack EE (1997) Tumours of the adrenal gland and extra-adrenal paraganglia. Armed Forces Institute of Pathology, WashingtonGoogle Scholar
- 16.Kimura N, Watanabe T, Noshiro T, Shizawa S, Miura Y (2005) Histological grading of adrenal and extra-adrenal pheochromocytomas and relationship to prognosis: a clinicopathological analysis of 116 adrenal pheochromocytomas and 30 extra-adrenal sympathetic paragangliomas including 38 malignant tumors. Endocr Pathol 16:23–32PubMedCrossRefGoogle Scholar
- 24.Anouar Y, Yon L, Guillemot J, Thouennon E, Barbier L, Gimenez-Roqueplo AP, Bertherat J et al (2006) Development of novel tools for the diagnosis and prognosis of phaeochromocltoma using peptide marker immunoassay and gene expression profiling approaches. Ann New York Acad Sci 1073:533–540CrossRefGoogle Scholar
- 30.Brown HM, Komorowski RA, Wilson SD, Demeure MJ, Zhu YR (1999) Predicting metastasis of pheochromocytomas using DNA flow cytometry and immunohistochemical markers of cell proliferation: a positive correlation between MIB-1 staining and malignant tumor behavior. Cancer 86:1583–1589PubMedCrossRefGoogle Scholar