Kajor Maciej, Ziaja Jacek, Król Robert, Ciupińska-Kajor Monika, Dobrosz Zuzanna, Heitzman Marek, Cierpka Lech
Department of Pathology, Medical University of Silesia, Katowice.
Endokrynol Pol. 2006 Mar-Apr;57(2):136-42.
A consequence of diagnosis of adrenocortical carcinoma (ACC) is introduction of pharmacological therapy, precise monitoring of the patients and in some cases re-operation. The aim of the study is to analyse morphology of adrenocortical tumours as regards their malignancy by use of criteria proposed by Weiss.
110 adrenocortical tumours in 107 patients were analysed (M 27.1%, F 72.9%; age 32 to 77 years, mean 55.2 +/- 9.7). Conn syndrome was diagnosed in 16 patients (14.9%), Cushing syndrome in 12 (11.2%), and virilisation in 3 (2.8%). In 76 patients (71.0%) biochemical tests did not reveal hormonal hyperactivity of the tumour.
In routine histopatological examination ACC was diagnosed in 6 tumours (5.4%), adrenocortical adenoma (ACA) in 92 (83.6%) and adrenocortical hyperplasia in 12 (10.9%). Nuclear grade III or IV was observed in 8 tumours (7.3%), mitotic rate > 5/50 high power fields in 6 (5.4%), atypical mitoses in 5 (4.5%), clear cells constituting < 25% of the tumour in 10 (9.1%), diffuse architecture in 8 (7.3%), necrosis in 16 (14.5%), veins infiltration in 4 (3.6%), sinusoids infiltration in 7 (6.3%), and tumour capsule infiltration in 5 (4.5%). Among ACC tumours 4-9 features of malignancy were present, among ACA--0-3 features. Statistical analysis revealed correlation between number of criteria proposed by Weiss and maximal tumour size (p < 0.05).
The structure and cell arrangement in adrenocortical adenoma are heterogeneous. Application of criteria proposed by Weiss in histopathological examination of adrenocortical tumours can be useful in differentiating adrenocortical adenoma from carcinoma.
肾上腺皮质癌（ACC）诊断后的一个结果是开始药物治疗、对患者进行精确监测，在某些情况下还需再次手术。本研究的目的是利用魏斯提出的标准分析肾上腺皮质肿瘤的形态学以判断其恶性程度。
对107例患者的110个肾上腺皮质肿瘤进行了分析（男性占27.1%，女性占72.9%；年龄32至77岁，平均55.2±9.7岁）。16例患者（14.9%）诊断为Conn综合征，12例（11.2%）为库欣综合征，3例（2.8%）为男性化。76例患者（71.0%）的生化检查未显示肿瘤的激素活性增强。
在常规组织病理学检查中，6个肿瘤（5.4%）诊断为ACC，92个（83.6%）为肾上腺皮质腺瘤（ACA），12个（10.9%）为肾上腺皮质增生。8个肿瘤（7.3%）观察到核分级为III或IV级，6个（5.4%）有丝分裂率>5/50高倍视野，5个（4.5%）有非典型有丝分裂，10个（9.1%）透明细胞占肿瘤的比例<25%，8个（7.3%）为弥漫性结构，16个（14.5%）有坏死，4个（3.6%）有静脉浸润，7个（6.3%）有血窦浸润，5个（4.5%）有肿瘤包膜浸润。在ACC肿瘤中存在4至9个恶性特征，在ACA中为0至3个特征。统计分析显示魏斯提出的标准数量与肿瘤最大尺寸之间存在相关性（p<0.05）。
肾上腺皮质腺瘤的结构和细胞排列是异质性的。在肾上腺皮质肿瘤的组织病理学检查中应用魏斯提出的标准有助于区分肾上腺皮质腺瘤和癌。
