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Pathologic Features of Prognostic Significance in Adrenocortical Carcinoma
Abstract
There are currently no well-established pathologic prognostic factors helpful in distinguishing low versus high grade adrenocortical carcinomas. The effect of 11 pathologic parameters on survival was investigated in 42 cases of adrenocortical carcinoma. Only one variable, mitotic rate, had a strong statistical association with patient outcome. The 21 patients with carcinomas with greater than 20 mitoses per 50 high power fields (hpf) had a median survival of 14 months, whereas the 21 patients with carcinomas with less than or equal to 20 mitoses had a median survival of 58 months (p less than 0.02). The presence of atypical mitoses, capsular invasion, tumor weight greater than 250 g, and size greater than 10 cm each showed a marginal statistical association with poor survival (p less than 0.06), whereas other features assessed, such as nuclear grade, presence of necrosis or of venous or sinusoidal invasion, character of the tumor cell cytoplasm, or architectural pattern, showed no statistical significance in predicting survival. It is proposed that adrenal cortical carcinomas with greater than 20 mitoses be designated high grade, whereas tumors with less than or equal to 20 mitoses be designated low grade.
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“A threshold above a Weiss score of 3 (also on the modified score) was associated with an increased risk of malignant behavior (112).”
From Adrenal incidentaloma (2020) · cites this paper as [112]
In the citing paper
“In the initial study by Weiss, the features with the strongest association to outcome were the mitotic rate >5/50 high powered field, atypical mitoses, and venous invasion (111) and in the second study by Weiss in 1989 the strongest association with patient outcome was the mitotic rate (112).”
From Adrenal incidentaloma (2020) · cites this paper as [112]
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BackgroundPresence of Kisspeptin-like Immunoreactivity in Human Adrenal Glands and Adrenal Tumors
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Diolombi, M. L., Khani, F., & Epstein, J. I. (2016) · Human Pathology · doi:10.1016/j.humpath.2016.02.017 · Cited by 10
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Gao, Z., Man, X., Li, Z., et al. (2019) · Oncology Reports · doi:10.3892/or.2019.7021 · Cited by 10
“Diagnosis of ACCs and ACAs was performed based on the histopathologic criteria (Weiss score ≥3 and 3, respectively) proposed by Weiss et al (18) and the modification proposed by Aubert et al (19).”
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“ACNs were examined using parameters corresponding to the Weiss criteria [17, 18], and PCCs and its catecholamine types were examined using parameters of the GAPP scoring system [19].”
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Pathologic Quiz Case: A 64-Year-Old Man With an Adrenal Mass
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“Inclusion criteria were: age ≥18 years, histologically confirmed diagnosis of ACC according to Weiss score [20], ENSAT stage I–III at diagnosis, complete tumor resection, defined as R0, R1 or RX resection on the basis of surgical and pathologic reports, availability of postoperative follow-up information, and regular…”
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“Other prognosis classifiers include the Ki67 index [8,16], Weiss score [16,17], CpG island methylation, and transcriptome-based classification [8].”
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Costa, R., Wesolowski, R., & Raghavan, D. (2011) · British Journal of Urology · doi:10.1111/j.1464-410x.2011.10464.x · Cited by 9
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“The adrenal tumor displayed 5 of 9 Weiss criteria (10) for malignancy: abundant necrosis, high mitotic count, atypical mitoses, nuclear pleomorphism and a diffuse architecture.”
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“Surgical resection is the treatment of choice in patients with adrenocortical carcinoma, and survival can be prolonged significantly among patients able to undergo radical excision [1,14].”
Gene-expression profiling of adrenocortical carcinoma
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“He found that mitotic activity is the most important pathologic determinant of survival in patients with ACC [29].”
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Dias, A. I. B. D. S., Fachin, C. G., de Avó, L. R. D. S., Frazão, C. V. G., Caran, E. M. M., Schettini, S., Alves, M. T. D. S., Ribeiro, R. C., & Abib, S. D. C. V. (2014) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2014.12.006 · Cited by 9
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Diseases of the adrenal cortex
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Recommendations for reporting of tumors of the adrenal cortex and medulla
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“A Weiss score of ≥ 3 suggests malignancy, whereas an ACT with a Weiss score of 0–2 is classified as benign [1, 6, 9] Nevertheless, a Weiss score of 2–3 presents challenges in accurately predicting the biological behavior of ACT, as tumors with this score often fall into a 'gray zone' between benign…”
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“The Weiss score system is the most widely used [15].”
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An Uncommon Presentation of Adrenal Cyst with Subclinical Cushing’s Syndrome: A Diagnosis Dilemma
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“to Weiss’s criteria [12], our case was diagnosed as a benign adenoma.”
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“Since children with ACN appear to have a more favorable outcome than adults and Weiss score (11) is not a good predictor of prognosis based on histopathological features (12), it is preferable to classify pediatric ACN as clinically benign or clinical malignant tumors, as suggested by Wieneke et al.”
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“However, it is also true that there are no other established histopathological or other parameters in carcinoma cells of predicting clinical outcome at this juncture, although some factors such as Ki67 LI and the combination of factors in Weiss criteria have been reported promising [13, 14].”
ResultAdrenocortical neoplasms in young children: age as a prognostic factor.
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“Distinction between benign and malignant adrenocortical tumors is mostly done using the Weiss scoring system that evaluates nine histological characteristics of the tumor (Table 2) [11].”
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“These tumor entities are discriminated according to gross and microscopic criteria, such as the Weiss score [3].”
BackgroundHandling and Pathology Reporting of Adrenal Gland Specimens
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“The Weiss histopathological system (WHS) is the most commonly used method for differentiating malignant from benign tumors [17,18].”
MethodProteome analysis of adrenal cortical tumors
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Histologic Criteria for Adrenocortical Proliferative Lesions: Value of Mitotic Figure Variability
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“Dominant” Myelolipoma Encasing Adrenal Cortical Carcinoma
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Hannick, J. H., Wang, L., Barkan, G. A., Perez, C. B., Bova, D., Albain, K. S., & Quek, M. L. (2013) · Urology · doi:10.1016/j.urology.2013.07.010 · Cited by 6
Feminizing Adrenocortical Carcinoma with Distant Metastases: Can Surgery Be Considered?
Fancellu, A., Pinna, A., & Porcu, A. (2014) · Clinics and Practice · doi:10.4081/cp.2014.651 · Cited by 6
Kwok, G., Zhao, J., Glover, A. R., Ip, J. C. Y., Sywak, M. S., Clifton-Bligh, R. J., Clarke, S. J., Robinson, B. G., & Sidhu, S. B. (2019) · ANZ Journal of Surgery · doi:10.1111/ans.15032 · Cited by 6
Pennanen, M., Tynninen, O., Kytölä, S. I., Ellonen, P., Mustonen, H. K., Heiskanen, I., Haglund, C. H., & Arola, J. T. (2020) · Journal of the Endocrine Society · doi:10.1210/jendso/bvaa018 · Cited by 6
“The histopathological diagnosis using the Weiss score [10, 11] for each tumor was reviewed by 2 endocrine pathologists (M.”
MethodSarcopenia is Associated with Reduced Survival following Surgery for Adrenocortical Carcinoma
Jong, M. C. D., Patel, N., Hassan-Smith, Z. K., Mihai, R., & Khan, S. (2021) · Endocrine Research · doi:10.1080/07435800.2021.1954942 · Cited by 6
“at the time of diagnosis, as patients over the age of 55 had a significantly worse OS compared with patients under 55 years of age, similar to previous data,(45) and a more advanced T-stage of the tumor as corroborated by others(8) as well as signs of capsular invasion on histological examination.(9) Due to the limite…”
ResultDome, J. S., Galindo, C. R., Spunt, S. L., & Santana, V. M. (2008) · Elsevier eBooks · doi:10.1016/b978-0-443-06694-8.50103-2 · Cited by 7
Wong, C.-L., Fok, C.-K., Chan, Y., Tam, V. H.-K., & Fung, L. M. (2022) · Case Reports in Endocrinology · doi:10.1155/2022/7395050 · Cited by 6
Perna, V., Taylor, N., Dorota Dworakowska, B., Schulte, K., Aylwin, S. J. B., Al‐Hashimi, F., & Díaz‐Cano, S. J. (2014) · Clinical Endocrinology · doi:10.1111/cen.12458 · Cited by 6
“, Taylor, N.F. et al. (2009) Use of urinary steroid profiling for diagnosing and monitoring adrenocortical tumours.”
BackgroundAdrenocortical Carcinoma Arising From a Long-standing Adrenal Mass
Cofield, K. R., Cantley, L. K., Geisinger, K. R., et al. (2005) · Mayo Clinic Proceedings · doi:10.4065/80.2.264 · Cited by 6
Adrenal Black Adenoma Associated with Cushing's Syndrome
Erem, C., Hacıhasanoğlu, A., Çinel, A., et al. (2004) · Endocrine · doi:10.1385/endo:25:3:253 · Cited by 6
Saeger, W. (2003) · Der Pathologe · doi:10.1007/s00292-003-0621-1 · Cited by 6
Metadata
- Authors
- Weiss, L. M., Medeiros, L. J., & Vickery, A. L.
- Affiliations
- Stanford University (US)
- Massachusetts General Hospital (US)
- Venue
- The American Journal of Surgical Pathology
- Published
- 1989-03
- Volume
- 13
- Issue
- 3
- Pages
- 202-206
- ISSN
- 0147-5185 (ISSN-L)
- OpenAlex
- W2023370041
- Cited by
- 818
- References
- 0
- Citations by year
- 2026: 13 · 2025: 21 · 2024: 19 · 2023: 20 · 2022: 33 · 2021: 30 · 2020: 34 · 2019: 22 · 2018: 27 · 2017: 30 · 2016: 31 · 2015: 40 · 2014: 38 · 2013: 33 · 2012: 34
- FWCI
- 8.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Surgical Pathology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Oncology › Renal cell carcinoma treatment
- Health Sciences › Medicine › Oncology › Sarcoma Diagnosis and Treatment
- Keywords
- adrenocortical carcinoma, prognostic factors, mitotic activity, tumor grade, survival, capsular invasion, tumor size, tumor weight, atypical mitoses, venous invasion, nuclear grade, necrosis
- MeSH terms
- Adolescent, Adrenal Cortex Neoplasms, Adult, Aged, Carcinoma, Child, Humans, Middle Aged, Mitotic Index, Neoplasm Invasiveness, Prognosis
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