Histological scores and tumor size on stage II in adrenocortical carcinomas

Author:

Oliveira Rui Caetano123ORCID,Martins Maria João14,Moreno Carolina45,Almeida Rui14,Carvalho João6,Teixeira Paulo1ORCID,Teixeira Miguel3,Silva Edgar Tavares2346,Paiva Isabel4,Figueiredo Arnaldo346,Cipriano Maria Augusta1

Affiliation:

1. Pathology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

2. Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

3. Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

4. Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal

5. Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

6. Urology and Renal Transplantation, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Abstract

Adrenocortical carcinomas (ACC) are aggressive tumors with a poor prognosis. Histological scores are advised for the diagnosis, however, there are borderline cases that may be misjudged as adrenocortical adenomas (ACA). The three main scores used are: Weiss Modified System (WMS), Reticulin Algorithm (RA), and Helsinki Score (HS). We intend to compare the accuracy of the three scores in ACC diagnosis and to identify predictive factors of overall survival (OS). Retrospective study (2004–2016) at Centro Hospitalar e Universitário de Coimbra of the adrenal tumors, classified as ACC or ACA, with a history of posterior tumor relapse/metastases, without lesions in the contralateral adrenal gland: 13F and 6M, with a median age of 51 ± 12.41 years. Nodules’ median size was 9.20 ± 6.2 cm. Patients had a median OS of 52 ± 18.6 months, with 57.9% and 46.3%, at 3 and 5 years. Seven patients had local recurrence and nine had metastases. Thirteen cases were in stage II. The WMS and the HS allowed a diagnosis of ACC in 15 cases and the RA defined ACC in 17 cases. All cases had, at least, focal disruption of the reticulin framework. More than 5 mitosis/50 HPF was associated with worse OS: 49.67 ± 21.43 versus 108.86 ± 14.02 months ( p = 0.026). In patients with stage II, tumor size ⩾10 cm was associated with worse OS: 19.25 ± 7.15 versus 96.11 ± 16.7 months ( p = 0.007), confirmed by multivariate analysis ( p = 0.031). The correct diagnosis of ACC is a pathologist responsibility. The RA seems the most accurate. Any loss of the reticulin framework should raise awareness for malignancy. In patients on stage II, a size ⩾10 cm is a predictor of worse prognosis.

Publisher

SAGE Publications

Subject

Oncology,Histology

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