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Difference between revisions of "Adrenal gland"
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→Microscopic: more
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===Microscopic=== | ===Microscopic=== | ||
Various criteria exist for this diagnosis. The most widely used is the ''Weiss criteria'', which is a big long clunker. | |||
====Adult==== | |||
=====Weiss criteria===== | |||
Three of the following:<ref name=pmid20551521>{{cite journal |author=Jain M, Kapoor S, Mishra A, Gupta S, Agarwal A |title=Weiss criteria in large adrenocortical tumors: a validation study |journal=Indian J Pathol Microbiol |volume=53 |issue=2 |pages=222–6 |year=2010 |pmid=20551521 |doi=10.4103/0377-4929.64325 |url=}}</ref> | |||
#High nuclear grade. | #High nuclear grade. | ||
#High mitotic rate. | #High mitotic rate; >5/50 HPF (@ 40X obj.) - definition suffers from [[HFPitis]]. | ||
#Atypical mitoses. | #Atypical mitoses. | ||
#Cleared cytoplasm in >= 25% of tumour cells. | #Cleared cytoplasm in >= 25% of tumour cells. | ||
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#Capsular invasion. | #Capsular invasion. | ||
=====Volante criteria===== | |||
#Reticular network disruption | There is a simplified set of criteria by ''Volante et al.'' - that is not widely used:<ref name=pmid19912359>{{cite journal |author=Volante M, Bollito E, Sperone P, ''et al.'' |title=Clinicopathological study of a series of 92 adrenocortical carcinomas: from a proposal of simplified diagnostic algorithm to prognostic stratification |journal=Histopathology |volume=55 |issue=5 |pages=535–43 |year=2009 |month=November |pmid=19912359 |doi=10.1111/j.1365-2559.2009.03423.x |url=}}</ref> | ||
#One of the following: | #Reticular network disruption (with reticulin staining). | ||
##Abundant mitoses >5/50 high-power fields | #One of the three following: | ||
##Abundant mitoses >5/50 high-power fields - definition suffers from [[HPFitis]]. | |||
##Necrosis. | ##Necrosis. | ||
##Vascular invasion. | ##Vascular invasion. | ||
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Notes: | Notes: | ||
*Tumour may contain fat.<ref name=pmid15688105>{{cite journal |author=Heye S, Woestenborghs H, Van Kerkhove F, Oyen R |title=Adrenocortical carcinoma with fat inclusion: case report |journal=Abdom Imaging |volume=30 |issue=5 |pages=641–3 |year=2005 |pmid=15688105 |doi=10.1007/s00261-004-0281-5 |url=}}</ref> | *Tumour may contain fat.<ref name=pmid15688105>{{cite journal |author=Heye S, Woestenborghs H, Van Kerkhove F, Oyen R |title=Adrenocortical carcinoma with fat inclusion: case report |journal=Abdom Imaging |volume=30 |issue=5 |pages=641–3 |year=2005 |pmid=15688105 |doi=10.1007/s00261-004-0281-5 |url=}}</ref> | ||
====Pediatric==== | |||
The criteria in the pediatric setting are somewhat different. This is discussed by Wieneke ''et al.''<ref name=pmid12826878>{{cite journal |author=Wieneke JA, Thompson LD, Heffess CS |title=Adrenal cortical neoplasms in the pediatric population: a clinicopathologic and immunophenotypic analysis of 83 patients |journal=Am. J. Surg. Pathol. |volume=27 |issue=7 |pages=867–81 |year=2003 |month=July |pmid=12826878 |doi= |url=}}</ref> and Dehner and Hill.<ref name=pmid19326954>{{cite journal |author=Dehner LP, Hill DA |title=Adrenal cortical neoplasms in children: why so many carcinomas and yet so many survivors? |journal=Pediatr. Dev. Pathol. |volume=12 |issue=4 |pages=284–91 |year=2009 |pmid=19326954 |doi=10.2350/08-06-0489.1 |url=}}</ref> | |||
Dehner and Hill propose a very simple system:<ref name=pmid19326954/> | |||
*"Low risk" < 200 g & confined to the adrenal. | |||
*"Intermediate risk" 200-400 g, no mets, +/-microscopic disease outside adrenal. | |||
*"High risk" >400 g, or mets, or gross invasion of adjacent structures. | |||
===IHC=== | ===IHC=== | ||