Dukaczewska Agata, Marticorena Garcia Stephan R, Ponsel Simon, Webster Alexandra, Butz Frederike, Dobrindt Eva M, Pratschke Johann, Horst David, Mogl Martina T, Kunze Catarina A
Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany.
Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany.
Curr Oncol. 2025 Jan 1;32(1):25. doi: 10.3390/curroncol32010025.
Necrosis in postoperative histology has been reported as being specific for adrenocortical carcinoma (ACC) compared to adenoma. We therefore retrospectively analyzed the diagnostic accuracy of the finding of necrosis in preoperative cross-sectional imaging and postoperative histology as a marker for ACC in our patient cohort. Among the 411 adrenalectomies in 396 patients performed between 2008 and April 2022, 30 cases of ACC (7.6%) were identified, with one tumor measuring less than 40 mm excluded. All 45 benign adrenocortical tumors of at least 40 mm in diameter, including Cushing, Conn, and hormonally inactive adenomas, served as controls. Preoperative imaging was available for 40 benign and 27 malignant adrenocortical tumors. In total, 10 of 40 (25%) benign adrenocortical tumors and 22 of 27 (81%) ACCs showed signs of possible necrosis in preoperative imaging. Pathologic examination confirmed necrosis in 1 of 40 (2.5%) benign tumors and in 26 out of 27 (96%) malignant tumors. The specificities of possible necrosis in preoperative imaging and necrosis in histology for diagnosing ACC were 75% and 97.5%, respectively, whereas the sensitivities were 81% and 96%, respectively. Signs of possible necrosis in radiologic imaging and tumor necrosis in histology proved to be very good predictive markers for the diagnosis of malignant adrenocortical tumors.
与肾上腺皮质腺瘤相比，术后组织学中的坏死被报道为肾上腺皮质癌（ACC）所特有。因此，我们回顾性分析了术前横断面成像中坏死发现及术后组织学中坏死作为ACC标志物在我们患者队列中的诊断准确性。在2008年至2022年4月期间对396例患者进行的411例肾上腺切除术病例中，确诊30例ACC（7.6%），排除1例直径小于40mm的肿瘤。所有45例直径至少40mm的良性肾上腺皮质肿瘤，包括库欣腺瘤、Conn腺瘤和无功能性腺瘤，作为对照。40例良性和27例恶性肾上腺皮质肿瘤有术前成像资料。总体而言，40例（25%）良性肾上腺皮质肿瘤中有10例以及27例（81%）ACC在术前成像中显示可能存在坏死迹象。病理检查证实40例（2.5%）良性肿瘤中有1例以及27例（96%）恶性肿瘤中有26例存在坏死。术前成像中可能坏死及组织学中坏死用于诊断ACC的特异性分别为75%和97.5%，而敏感性分别为81%和96%。放射学成像中可能坏死迹象及组织学中肿瘤坏死被证明是诊断恶性肾上腺皮质肿瘤的非常好的预测标志物。
