Division of Pathology, Department of Clinical and Biological Sciences, University of Turin at San Luigi Hospital, Turin, Italy.
Histopathology. 2009 Nov;55(5):535-43. doi: 10.1111/j.1365-2559.2009.03423.x.
Pathological diagnosis of adrenocortical carcinoma relies on several microscopic features commonly used in combination in different scoring systems that are sometimes subjective and/or time consuming. The aim was to investigate the impact of individual pathological parameters in the diagnosis and prognosis of adrenocortical carcinoma.
The series included 92 malignant cases and a control series of 47 adenomas, all classified according to Weiss score criteria. The presence of disruption of the reticular network, as highlighted by histochemical staining, was present in all adrenocortical carcinomas and the inclusion of at least one of the three following additional parameters - mitotic index >5/50 high-power fields (HPF), presence of necrosis and presence of vascular invasion - gave an algorithm with 100% sensitivity and specificity to recognize malignant tumours according to the Weiss system, with easier and more practical applicability. Moreover, on multivariate analysis, stage III/IV and mitotic count >9/50 HPF showed a strong adverse impact on disease-free and overall survival, leading to the identification of three risk groups affected by a significantly different prognosis.
We have defined an easy-to-perform and highly specific and sensitive algorithm for the diagnosis and prognostic categorization of adrenocortical tumours.
肾上腺皮质癌的病理诊断依赖于几种常用于不同评分系统的微观特征，这些特征有时具有主观性和/或耗时。目的是研究个体病理参数对肾上腺皮质癌的诊断和预后的影响。
该系列包括 92 例恶性病例和 47 例腺瘤对照病例，均根据 Weiss 评分标准进行分类。所有肾上腺皮质癌中均存在网状网络中断，这是通过组织化学染色突出显示的，并且至少包含以下三个附加参数中的一个 - 有丝分裂指数>5/50 高倍视野（HPF），存在坏死和存在血管侵犯 - 根据 Weiss 系统，给出了一种具有 100%敏感性和特异性的算法，用于识别恶性肿瘤，其具有更简单、更实用的适用性。此外，多变量分析显示，III/IV 期和有丝分裂计数>9/50 HPF 对无病和总生存有强烈的不利影响，导致确定了三个受显著不同预后影响的风险组。
我们已经定义了一种易于执行的、高度特异和敏感的算法，用于诊断和预后分类肾上腺皮质肿瘤。
