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

Authors

  • Venugopal Madabhushi Department of Pathology, Guntur Medical College, Guntur, Andhra Pradesh
  • Padmavathi Devi Chaganti Department of Pathology, Guntur Medical College, Guntur, Andhra Pradesh
  • Ramya Katta Department of Pathology, Guntur Medical College, Guntur, Andhra Pradesh
  • Nageswararao Kakumanu Department of Pathology, Guntur Medical College, Guntur, Andhra Pradesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20160817

Keywords:

Adrenal cortical tumours, Adenoma, Adrenal cortical carcinoma, Weiss criteria, Immunohistochemistry

Abstract

Background: Primary neoplasms arising in both adrenal cortex and adrenal medulla are rare tumors. Adrenal cortical tumours may be functional or non-functional. They may be found incidentally at the time of autopsy. In many cases adrenal lesions are identified during a radiologic investigation conducted for indications other than an evaluation for adrenal disease. Adrenocortical tumours can be categorized into adenomas and carcinomas, but the distinction becomes difficult in many cases. Several parameters have been applied to establish malignancy in these tumours. Histopathology is still the gold standard in diagnosis of adrenal tumours. This is a retrospective study and was to study the incidence of tumours of adrenal cortex and to assess the role of histopathological criteria and utility of immunohistochemistry in the diagnosis.

Methods: Adrenal cortical tumors reported from August, 2008 to August, 2015 in the Department of Pathology, Guntur Medical College, Andhra Pradesh, India are taken for the study. Clinical data including age, sex and symptoms at presentation, are retrieved from the archives. The resected specimens received from Government General Hospital, Guntur, Andhra Pradesh, India are routinely processed and multiple sections stained with Haematoxylin & Eosin are examined. Modified Weiss criteria are applied for all adrenal cortical tumors in the study. Immunohistochemistry is done in relevant cases for confirmation of diagnosis.

Results: The observations in the study including clinical presentation, gross and histological features are tabulated.

Conclusions: The study highlights the crucial role of histopathological parameters, especially Weiss criteria in identifying malignancy in tumours of adrenal cortex and importance of immunohistochemistry in differential diagnosis.

 

References

De Lellis RA, Lloyd RV, Heitz PU. World Health Organization Classification of Tumors. Pathology and Genetics of Tumors of Endocrine Organs. IARC Press: Lyon, France. 2004;137-146.

Weiss LM. Comparative histologic study of 43 metastasizing and nonmetastasizing adrenocortical tumors. Am J Surg Pathol. 1984;8:163-9.

Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982;6:655-63.

Hough AJ, Hollifield JW, Page DL. Prognostic factors in adrenal cortical tumors. A mathematical analysis of clinical and morphologic data. Am J Clin Pathol. 1979;72:390-9.

Van Slooten H, Schaberg A, Smeenk D, Moolenaar AJ. Morphologic characteristics of benign and malignant adrenocortical tumors. Cancer. 1985;55:766-73.

Weiss LM, Medeiros LJ, Vickery AL. Pathologic features of prognostic significance in adrenocortical carcinoma.Am J Surg Pathol. 1989;13:202-6.

Aubert S, Wacrenier A, Leroy X, Devos P, Carnaille B, Proye C, et al. Weiss system revisited: a clinicopathologic and immunohistochemical study of 49 adrenocortical tumors. Am J Surg Pathol. 2002;26:1612-9.

Biscegha M, Ludovico O, Di Mattia A. Adrenal oncocytic tumors: report of 10 cases and review of the literature. Int J Surg Pathol. 2004;12:231-43.

Gandour MJ, Grizzle WE: A small adrenocortical carcinoma with aggressive behavior. An evaluation of criteria for malignancy. Arch Pathol Lab Med. 1986;110:1076-9.

HS Tan, AC Thai, ME Nga, JJ Mukherjee. Development of Ipsilateral Adrenocortical Carcinoma Sixteen Years after Resection of an Adrenal Tumour Causing Cushing’s Syndrome. Ann Acad Med Singapore. 2005;34:271-4.

Volante M, Bollito E, Sperone P, Tavaglione V, Daffara F, Porpiglia F, et al: Clinicopathological study of a series of 92 adrenocortical carcinomas: from a proposal of simplified diagnostic algorithm to prognostic stratification. Histopathology. 2009;55:535-43.

De Lellis RA, Lloyd RV, Heitz PU. World Health Organization Classification of Tumors. Pathology and Genetics of Tumors of Endocrine Organs. IARC Press: Lyon, France. 2004;140-3.

Stojadinovic A, Brennan MF, Hoos A, Omeroglu A, Leung DHY, Dudas ME, et al: Adrenocortical adenoma and carcinoma: histopathological and molecular comparative analysis. Mod Pathol. 2003;16:742-51.

Mufaddal TM, Johnson SJ. Standards and datasets for reporting cancers Cancer dataset for the histological reporting of adrenal cortical carcinoma and phaeochromocytoma. PSU 170112 1 V5 Final. 2012: G109:7-9.

Evans HL, Vassilopoulou-Sellin R: Adrenal cortical neoplasms. A study of 56 cases. Am J Clin Pathol. 1996;105:76-86.

Sasano H, Suzuki T, Moriya T: Discerning malignancy in resected adrenocortical neoplasms. Endocr Pathol. 2002;12:397-406.

Kay S: Hyperplasia and neoplasia of the adrenal gland. Pathol Annu. 1976;11:103-39.

Wieneke JA, Thompson LD, Heffess CS. Adrenal cortical neoplasm in the pediatric population: a clinicopathologic and immunophenotypic analysis of 83 patients. Am J Surg Pathol. 2003;27:867-81.

Ricardo V. Lloyd Adrenal cortical tumors, pheochromocytomas and paragangliomas Modern Pathology. 2011;24:S58-S65.

LM Munro. A Kennedy and AM McNicol. The expression of inhibin/activin subunits in the human adrenal cortex and its tumours. J Endocrinol. 1999;161:341-67.

Busam KJ, Iversen K, Coplan KA, Old LJ, Stockert E, Chen YT, et al: Immunoreactivity for A103, an antibody to melan-A (Mart-1), in adrenocortical and other steroid tumors. Am J Surg Pathol. 1998;22:57-63.

Wick MR, Cherwitz DL, McGlennen RC, Dehner LP. Adrenocortical carcinoma. An immunohistochemical comparison with renal cell carcinoma Am J Pathol. 1986;122(2):343-52.

Jain M, Kapoor S, Mishra A, Gupta S, Agarwal A. Weiss criteria in large adrenocortical tumors: a validation study. Indian J Pathol Micobiol. 2010;53:222-6.

Downloads

Published

2016-12-28

How to Cite

Madabhushi, V., Chaganti, P. D., Katta, R., & Kakumanu, N. (2016). Cracking the diagnostic puzzle of tumours of adrenal cortex: a histopathological study. International Journal of Research in Medical Sciences, 4(4), 1242–1247. https://doi.org/10.18203/2320-6012.ijrms20160817

Issue

Section

Original Research Articles