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?
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.
KeywordsRenal Cell Carcinoma Adrenal Mass Adrenocortical Carcinoma Adrenocortical Adenoma Adrenal Cortical Carcinoma
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- 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
- 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
- 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
- 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