Kim Byung-Chang, Han HyeJin, Kwon Douk, Pak Shin Jeong, An Hyeong Rok, Kim Won Woong, Lee Yu-Mi, Lee Seung Hun, Koh Jung-Min, Lee Jae Lyun, Chung Ki-Wook, Song Dong Eun, Sung Tae-Yon
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea.
Department of Surgery, Hanyang University College of Medicine, Seongdong-gu, Seoul, Korea.
Ther Adv Endocrinol Metab. 2025 Apr 30;16:20420188251328186. doi: 10.1177/20420188251328186. eCollection 2025.
Oncocytic adrenocortical neoplasms (OANs) are extremely rare adrenal tumors whose diagnosis is challenging. This study aimed to identify risk factors for predicting poor prognosis in patients with OAN of uncertain malignant potential (OANUMP) and oncocytoma, OAN subtypes, and to evaluate the diagnostic utility of the current Lin-Weiss-Bisceglia (LWB) criteria.
We retrospectively reviewed 14 patients diagnosed with OANUMP or oncocytoma after adrenalectomy from February 2002 to May 2022. Patients re-classified as oncocytic adrenocortical carcinoma by the LWB criteria were excluded. We compared the clinicopathological and radiological features between patients with and without recurrence.
Among the 14 patients, recurrence occurred in 3 (21%; 2 (67%) and 1 (33%) patients with OANUMP and oncocytoma, respectively). The proportion of patients with necrosis (66.7% vs 9.1%, = 0.093), a Helsinki score >5 (66.7% vs 9.1%, = 0.093), and malignancy by the reticulin algorithm (66.7% vs 9.1%, = 0.093) were higher in the recurrence group than in the no-recurrence group but were not statistically significant. The percentages of patients with an indeterminate pathological resection margin (100% vs 63.6%, = 0.192) tended to be higher in the recurrence group than in the no-recurrence group. Of the three patients with recurrence, two had tumor necrosis on the final pathology and were classified as malignant by the reticulin algorithm. One patient diagnosed as OANUMP by the LWB criteria had tumor necrosis and was classified as malignant by the reticulin algorithm and Helsinki scoring system.
Necrosis was associated with the recurrence of disease in patients with OANUMP according to the LWB criteria. The absence of necrosis as a major criterion in the current LWB criteria highlights its potential limitation in accurately assessing disease aggressiveness in OANs.
嗜酸细胞性肾上腺皮质肿瘤（OANs）是极为罕见的肾上腺肿瘤，其诊断具有挑战性。本研究旨在确定预测恶性潜能不确定的嗜酸细胞性肾上腺皮质肿瘤（OANUMP）和嗜酸细胞瘤（OAN的亚型）患者预后不良的危险因素，并评估当前的林-魏斯-比塞利亚（LWB）标准的诊断效用。
我们回顾性分析了2002年2月至2022年5月期间14例肾上腺切除术后诊断为OANUMP或嗜酸细胞瘤的患者。排除经LWB标准重新分类为嗜酸细胞性肾上腺皮质癌的患者。我们比较了复发患者和未复发患者的临床病理和影像学特征。
14例患者中，3例（21%）复发；其中OANUMP患者2例（67%），嗜酸细胞瘤患者1例（33%）。复发组患者中出现坏死的比例（66.7%对9.1%，P = 0.093）、赫尔辛基评分>5的比例（66.7%对9.1%，P = 0.093）以及网硬蛋白算法判定为恶性的比例（66.7%对9.1%，P = 0.093）均高于未复发组，但差异无统计学意义。复发组患者病理切缘不确定的比例（100%对63.6%，P = 0.192）也倾向于高于未复发组。在3例复发患者中，2例最终病理显示肿瘤坏死，经网硬蛋白算法判定为恶性。1例经LWB标准诊断为OANUMP的患者有肿瘤坏死，经网硬蛋白算法和赫尔辛基评分系统判定为恶性。
根据LWB标准，坏死与OANUMP患者的疾病复发相关。当前LWB标准中缺乏将坏死作为主要标准，凸显了其在准确评估OANs疾病侵袭性方面的潜在局限性。
