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Presented by George Netto, M.D. and prepared by Priya Banerjee, M.D.
Case 1: A 45 year old woman with abdominal pain was found to have a 9.5 cm (162 gm) right adrenal mass.
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Question 1 of 1
1. Question
Week 362: Case 1
A 45 year old woman with abdominal pain was found to have a 9.5 cm (162 gm) right adrenal mass.images/8_18_08 1a.jpg
images/8_18_08 1a.jpg
images/8_18_08 1a.jpg
images/8_18_08 1a.jpgCorrect
Answer: Adrenal cortical carcinoma
Histology: In our current example, the diagnosis of cortical carcinoma is supported by the tumor size (above 5 cm), tumor weight (above 100 gm), marked nuclear atypia (equivalent to RCC Fuhrman nuclear grade 3), presence of vascular venous invasion, diffuse architecture, high mitotic rate (>5 /50HPF), presence of atypical mitotic figures and almost total lack of cytoplasmic clearing.
Discussion: The above features satisfy more than four of the originally proposed Weiss criteria for predicting high likelihood of aggressive biologic behavior (in the form of reccurrence and or metastasis) in adrenocortical neoplasms. The remaining features in Weiss scheme included the presence of necrosis, capsular invasion. Lesions with less than two of the above criteria never metastasized. In a later study by Weiss et al, the threshold for malignant behavior was lowered to the presence of three rather than four of the above features. Further more a cut off of 20/50HPF was demonstrated to predict worse prognosis within cortical carcinomas.
Reference(s):
– Weiss LM. Comparative histological study of 43 metastasizing and nonmetastasizing adenocortical tumors. Am J Surg pathol 1984;8:163-169.
– Weiss LM, Medeiros LJ, Vickery AL Jr. Pathologic features of prognostic significance in adrenocortical carcinoma. Am J Surg Pathol. 1989;13(3):202-6.Incorrect
Answer: Adrenal cortical carcinoma
Histology: In our current example, the diagnosis of cortical carcinoma is supported by the tumor size (above 5 cm), tumor weight (above 100 gm), marked nuclear atypia (equivalent to RCC Fuhrman nuclear grade 3), presence of vascular venous invasion, diffuse architecture, high mitotic rate (>5 /50HPF), presence of atypical mitotic figures and almost total lack of cytoplasmic clearing.
Discussion: The above features satisfy more than four of the originally proposed Weiss criteria for predicting high likelihood of aggressive biologic behavior (in the form of reccurrence and or metastasis) in adrenocortical neoplasms. The remaining features in Weiss scheme included the presence of necrosis, capsular invasion. Lesions with less than two of the above criteria never metastasized. In a later study by Weiss et al, the threshold for malignant behavior was lowered to the presence of three rather than four of the above features. Further more a cut off of 20/50HPF was demonstrated to predict worse prognosis within cortical carcinomas.
Reference(s):
– Weiss LM. Comparative histological study of 43 metastasizing and nonmetastasizing adenocortical tumors. Am J Surg pathol 1984;8:163-169.
– Weiss LM, Medeiros LJ, Vickery AL Jr. Pathologic features of prognostic significance in adrenocortical carcinoma. Am J Surg Pathol. 1989;13(3):202-6.
