Questions in Daily Urologic Practice pp 271-276 | Cite as
What are the pathologic criteria for distinguishing benign from malignant adrenal cortical neoplasms? What diseases should be considered for the differential diagnosis? Are there significant differences in clinical behavior between adult and pediatric adrenal cortical neoplasms?
Chapter
Abstract
One of the important criteria for malignancy is tumor size. Tumors weighing >100g make up more than 90% of adrenal cortical carcinomas and only 6% of cortical adenomas. The presence of hemorrhage and/or necrosis may also be indicative of malignancy. The microscopic criteria set by the Weiss group has been commonly used. Those tumors fulfilling more than three of nine features should be regarded malignant. Among the carcinomas, those with >20 mitotic figures per 50 high power fields behave more aggressively than those with <20 mitoses.
Keywords
Renal Cell Carcinoma Adrenal Mass Adrenocortical Carcinoma Adrenocortical Adenoma Adrenal Cortical Carcinoma
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Preview
Unable to display preview. Download preview PDF.
References
- 1.Ross NS, Aron DC (1990) Hormonal evaluation of the patient with an incidentally discovered adrenal mass. N Engl J Med 323:1401–1405.PubMedGoogle Scholar
- 2.Abecasses M, McLoughlin MJ, Langer B, Kudlow JE (1985) Serendipitous adrenal masses: prevalence, significance, and management. Am J Surg 149:783–788.CrossRefGoogle Scholar
- 3.Hedeland H, Ostberg G, Hokfelt B (1968) On the prevalence of adrenocortical adenoma in an autopsy material in relation to hypertension and diabetes. Acta Med Scand 184:211–214.PubMedGoogle Scholar
- 4.Mansmann G, Lau J, Balk E, Rothberg M, Miyachi Y, Bornstein SR (2004) The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 25:309–340.PubMedCrossRefGoogle Scholar
- 5.Young WF Jr (2007) The incidentally discovered adrenal mass. N Engl J Med 356:601–610.PubMedCrossRefGoogle Scholar
- 6.Weiss LM, Medeiros LJ, Vickery AL (1989) Pathologic features of prognostic significance in adrenocortical carcinoma. Am J Surg Pathol 13:202–206.PubMedGoogle Scholar
- 7.Wooten MD, King DK (1993) Adrenal cortical carcinoma: epidemiology and treatment with mitotane and a review of the literature. Cancer 72:3145–3155.PubMedCrossRefGoogle Scholar
- 8.Cohn K, Gottesman L, Brennan M (1986) Adrenocortical carcinoma. Surgery 100:1170–1177.PubMedGoogle Scholar
- 9.Venkatesh S, Hickey RC, Sellin RV, Fernandez JF, Samaan NA (1989) Adrenal cortical carcinoma. Cancer 64:765–769.PubMedCrossRefGoogle Scholar
- 10.Lack EE (1997) Tumors of the adrenal gland and extraadrenal paraganglia. In: Atlas of tumor pathology 19. Armed Forces Institute of Pathology, Washington, DC.Google Scholar
- 11.Lack EE, Travis D (1995) Diagnostic problems in surgical pathology of the adrenal glands. Mod Pathol 8: 312–332.PubMedGoogle Scholar
- 12.Sasano H (2006) Histopathology and immunohisto-chemistry of adrenal cortical adenoma and carcinoma. Presented at the United States and Canadian Academy of Pathology Annual Meeting, February 2006, Atlanta.Google Scholar
- 13.LeFevre M, Gerard-Marchant R, Gubler JP, Chaussain JL, Lemerle J (1983) Adrenal cortical carcinoma in children: 42 patients treated from 1958 to 1980 at Villejuif. In: Humphrey GB, Grindey GB, Dehner LP, Acton RT, Pycher TJ (eds) Adrenal and endocrine tumors in children. Martinus Nijhoff, Boston, pp 265–276.Google Scholar
- 14.Gandour MJ, Grizzle WE (1986) A small adrenocortical carcinoma with aggressive behavior: an evaluation of criteria for malignancy. Arch Pathol Lab Med 110:1076–1079.PubMedGoogle Scholar
- 15.Neville AM, O’Hare MJ (1985) Histopathology of the human adrenal cortex. Clin Endocrinol Metab 14:791–820.PubMedGoogle Scholar
- 16.Weiss LM (1984) Comparative histologic study of 43 metastasizing and nonmetastasizing adrenal cortical tumors. Am J Surg Pathol 8:163–170.PubMedCrossRefGoogle Scholar
- 17.Fuhrman SA, Lasky LC, Limas C (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6:655–663.PubMedGoogle Scholar
- 18.Vargas MP, Vargas HI, Kleiner DE, Merino MJ (1997) Adrenocortical neoplasms: role of prognostic markers MiB-1, p 53, and RB. Am J Surg Pathol 21:556–562.PubMedCrossRefGoogle Scholar
- 19.Sasano H, Saito Y, Sato I, Sasano N, Nagura H (1990) Nuclear organizer regions in human adrenocortical disorders. Mod Pathol 3:591–595.PubMedGoogle Scholar
- 20.Suzuki T, Sasano H, Nisikawa T, Rhame J, Wilkinson DS, Nagura H (1992) Discerning malignancy in human adrenocortical neoplasms; utility of DNA flow cytometry and immunohistochemistry. Mod Pathol 5:224–231.PubMedGoogle Scholar
- 21.Cote RJ, Cordon-Cardo C, Reuter VE, Rosen PP (1990) Immunopathology of adrenal and renal cortical tumors: coordinated change in antigen expression is associated with neoplastic conversion in the adrenal cortex. Am J Pathol 136:1077–1084.PubMedGoogle Scholar
- 22.Gaffey MJJ, Traweek ST, Mills SE, Travis WD, Lack EE, Medeiros LJ, Weiss LM (1992) Cyto-keratin expression in adrenocortical neoplasia: an immuno-histochemical and biochemical study with implications for the differential diagnosis of adrenocortical, hepatocellular, and renal cell carcinoma. Hum Pathol 23:144–153.PubMedCrossRefGoogle Scholar
- 23.Wick MR, Cherwitz DL, McGlennan RC, Dehner LP (1986) Adrenocortical cacrcinoma: an immunohistochemical comparison with renal cell carcinoma. Am J Pathol 122:343–352.PubMedGoogle Scholar
- 24.Medeiros LJ, Michie SA, Johnson DE, Warnke RA, Weiss LM (1988) An immunoperoxidase study of renal cell carcinomas: correlation with nuclear grade, cell type, and histologic pattern. Hum Pathol 19:980–987.PubMedCrossRefGoogle Scholar
- 25.Sasano H, Shizawa S, Suzuki T, Takayama K, Fukuya T, Morohashi K, Nagura H (1995) Transcription factor adrenal 4 binding protein as a marker of adrenocortical malignancy. Hum Pathol 26:1154–1156.PubMedCrossRefGoogle Scholar
- 26.Chu PG, Ishizawa S, Wu E, Weiss LM (2002) Hepatocyte antigen as a marker of hepatocellular carcinoma: an immunohistochemical comparison to carcinoembryonic antigen, CD10, and alpha-fetoprotein. Am J Surg Pathol 26:978–988.PubMedCrossRefGoogle Scholar
- 27.Ribeiro RC, Neto RS, Schell MJ, Lacerda L, Sambaio GA, Cat I (1990) Adrenocortical carcinoma in children: a study of 40 cases. J Clin Oncol 8:67–74.PubMedGoogle Scholar
- 28.Mendonca BB, Lucon AM, Menezes CAV, Saldanha LB, Latronico AC, Zerbini C, Madureira G, Domenice S, Albergaria MAP, Camargo MHA, Halpern A, Liberman B, Arnhold IJP, Bloise W, Andriolo A, Nicolau W, Silva FAQ, Wroclaski E, Arap S, Wajchenberg BL (1995) Clinical, hormonal and pathological findings in a comparative study of adrenocortical neoplasms in childhood and adulthood. J Urol 154: 2004–2009.PubMedCrossRefGoogle Scholar
- 29.Cagle PT, Hough AJ, Pysher TJ, Page DL, Johnson EH, Kirkland RT, Holcombe JH, Hawkins EP (1986) Comparison of adrenal cortical tumors in children and adults. Cancer 57:2235–2237.PubMedCrossRefGoogle Scholar
Copyright information
© Springer 2008