10.1038_modpathol.2016.8.pdf (9.72 MB)
Oncocytic Adrenocortical Adenomas: An Important Cause of False Positive Malignant Results in Preoperative Urine Steroid Profiling
journal contribution
posted on 2016-03-20, 14:06 authored by Salvador J. Diaz-CanoSalvador J. Diaz-Cano, C Zhang, N TaylorBackground: The diagnosis of malignancy in adrenocortical neoplasms can be challenging, especially for lesions of heterogeneous appearance and large size that suggest a malignant behavior. The urinary steroid pro le (USP) has been used as a successful preoperative tool to distinguish adenomas (ACA) from carcinomas (ACC). The presence of oncocytic changes in adenomas (ACA-Onc) can contribute to confusion with ACC and its USP remains unknown.
Objective: To evaluate the features of ACA-Onc in comparison with other adrenocortical neoplasms.
Design: We selected consecutive ACA (15), ACA-Onc (7) and ACC (18) cases for which USP analysis was performed before surgery and tissue were available for histological evaluation (King’s College Hospital, 2005-2014). Cases were classi ed according to WHO and Armed Forces Institute of Pathology criteria. USPs were obtained by gas chromatography/mass spectrometry. Total excretion of individual steroids and Indices (sums and ratios chosen to re ect steroid metabolic activity) were compared between ACA-Onc, ACA, and ACC. Steroids that have proved to be useful markers of ACC were also compared empirically between groups, including tetrahydro-11-deoxycortisol, pregnene3,16,20-triols, 16a- and 21-hydroxypregnenolone and tetrahydro-11-deoxycorticosterone.
Results: In comparison with ACA, tumors in ACA-Onc were significantly larger (10.3±2.1 vs. 3.5±1.0, P=0.002), presented in older patients and showed relatively higher incidence in males. Mitotic gure counts were signi cantly lower (0.32±0.04 vs. 0.95±0.10 in ACA, p=0.001) and revealed higher frequency of apoptotic cells (97% vs. 9% in ACA, p= 0.001). The USP of ACA-Onc showed diagnostic features of ACC, including 3α/3β ratios of pregnanetriol metabolites.
Conclusions: Oncocytic ACA reveals distinctive histological features, and USP markers suggestive of malignancy. It is important to recognize ACA-Onc because its size and heterogeneous appearance raise the possibility of ACC; in this context, USP alone cannot be used as a reliable tool for a correct preoperative diagnosis predicting the behavior of oncocytic adrenocortical neoplasms.
Objective: To evaluate the features of ACA-Onc in comparison with other adrenocortical neoplasms.
Design: We selected consecutive ACA (15), ACA-Onc (7) and ACC (18) cases for which USP analysis was performed before surgery and tissue were available for histological evaluation (King’s College Hospital, 2005-2014). Cases were classi ed according to WHO and Armed Forces Institute of Pathology criteria. USPs were obtained by gas chromatography/mass spectrometry. Total excretion of individual steroids and Indices (sums and ratios chosen to re ect steroid metabolic activity) were compared between ACA-Onc, ACA, and ACC. Steroids that have proved to be useful markers of ACC were also compared empirically between groups, including tetrahydro-11-deoxycortisol, pregnene3,16,20-triols, 16a- and 21-hydroxypregnenolone and tetrahydro-11-deoxycorticosterone.
Results: In comparison with ACA, tumors in ACA-Onc were significantly larger (10.3±2.1 vs. 3.5±1.0, P=0.002), presented in older patients and showed relatively higher incidence in males. Mitotic gure counts were signi cantly lower (0.32±0.04 vs. 0.95±0.10 in ACA, p=0.001) and revealed higher frequency of apoptotic cells (97% vs. 9% in ACA, p= 0.001). The USP of ACA-Onc showed diagnostic features of ACC, including 3α/3β ratios of pregnanetriol metabolites.
Conclusions: Oncocytic ACA reveals distinctive histological features, and USP markers suggestive of malignancy. It is important to recognize ACA-Onc because its size and heterogeneous appearance raise the possibility of ACC; in this context, USP alone cannot be used as a reliable tool for a correct preoperative diagnosis predicting the behavior of oncocytic adrenocortical neoplasms.
