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Abstract：
BACKGROUND: Current diagnostic criteria of adrenocortical neoplasms are mostly based on morphology. The utility of immunohistochemistry (IHC) and histochemistry is limited.
METHODS: To evaluate the diagnostic and prognostic utility of clinicopathological features, morphology, ancillary biomarkers, and reticular histochemistry in adrenocortical neoplasms. We examined 28 adrenocortical carcinomas (ACCs) and 50 adrenocortical adenomas (ACAs) obtained from pathology archives. Clinical data were retrieved from medical records. Two pathologists independently assessed hematoxylin and eosin-stained slides, employing modified Weiss criteria for all tumors and Lin-Weiss-Bisceglia criteria for oncocytic variants. Immunohistochemical markers (Calretinin, alpha-inhibin, MelanA, SF-1, Ki-67, PHH3, IGF-2, β-catenin, P53, CYP11B1, CYP11B2, MLH1, MSH2, MSH6, PMS2, EPCAM) and Gomori\'s Silver histochemistry were applied. Statistical analysis utilized SPSS Statistics 26.
RESULTS: ACCs exhibited larger tumor sizes (P<0.001) and symptomatic presentations (P = 0.031) compared to ACAs. Parameters of modified Weiss criteria and angioinvasion demonstrated diagnostic value for ACCs. Six immunohistochemical antibodies((MelanA, Ki-67, IGF-2, β-catenin, P53 and CYP11B1) and reticulin framework alterations showed diagnostic value. Notably, Ki-67 and reticulin staining were most recommended. Evident reticulin staining was frequently present in ACCs (P<0.001). Ki-67 was significantly higher in ACCs (P<0.001). Twenty-one conventional and seven oncocytic entities showed different necrosis frequencies. Symptoms and Ki-67 index ≥ 30% were prognostic for ACCs, correlating with shorter survival.
CONCLUSIONS: This study emphasizes the diagnostic value of reticulin framework alterations and a high Ki-67 index. Markers such as CYP11B1, IGF2, P53, β-catenin and MelanA also contribute to the diagnosis of ACCs. Symptoms and Ki-67 index ≥ 30% predict shorter survival. These findings encourges the use of ancillary markers such as reticulin histochemistry and Ki-67 in the workup of evaluations of adrenocortical neoplasms.
METHODS: To evaluate the diagnostic and prognostic utility of clinicopathological features, morphology, ancillary biomarkers, and reticular histochemistry in adrenocortical neoplasms. We examined 28 adrenocortical carcinomas (ACCs) and 50 adrenocortical adenomas (ACAs) obtained from pathology archives. Clinical data were retrieved from medical records. Two pathologists independently assessed hematoxylin and eosin-stained slides, employing modified Weiss criteria for all tumors and Lin-Weiss-Bisceglia criteria for oncocytic variants. Immunohistochemical markers (Calretinin, alpha-inhibin, MelanA, SF-1, Ki-67, PHH3, IGF-2, β-catenin, P53, CYP11B1, CYP11B2, MLH1, MSH2, MSH6, PMS2, EPCAM) and Gomori\'s Silver histochemistry were applied. Statistical analysis utilized SPSS Statistics 26.
RESULTS: ACCs exhibited larger tumor sizes (P<0.001) and symptomatic presentations (P = 0.031) compared to ACAs. Parameters of modified Weiss criteria and angioinvasion demonstrated diagnostic value for ACCs. Six immunohistochemical antibodies((MelanA, Ki-67, IGF-2, β-catenin, P53 and CYP11B1) and reticulin framework alterations showed diagnostic value. Notably, Ki-67 and reticulin staining were most recommended. Evident reticulin staining was frequently present in ACCs (P<0.001). Ki-67 was significantly higher in ACCs (P<0.001). Twenty-one conventional and seven oncocytic entities showed different necrosis frequencies. Symptoms and Ki-67 index ≥ 30% were prognostic for ACCs, correlating with shorter survival.
CONCLUSIONS: This study emphasizes the diagnostic value of reticulin framework alterations and a high Ki-67 index. Markers such as CYP11B1, IGF2, P53, β-catenin and MelanA also contribute to the diagnosis of ACCs. Symptoms and Ki-67 index ≥ 30% predict shorter survival. These findings encourges the use of ancillary markers such as reticulin histochemistry and Ki-67 in the workup of evaluations of adrenocortical neoplasms.
摘要：
背景：目前肾上腺皮质肿瘤的诊断标准主要基于形态学。免疫组织化学(IHC)和组织化学的应用是有限的。
方法：为了评估临床病理特征的诊断和预后效用，形态学,辅助生物标志物，和肾上腺皮质肿瘤的网状组织化学。我们检查了从病理档案中获得的28例肾上腺皮质癌（ACC）和50例肾上腺皮质腺瘤（ACA）。从医疗记录中检索临床数据。两名病理学家独立评估了苏木精和伊红染色的载玻片，对所有肿瘤采用改良的Weiss标准，对嗜酸细胞变异体采用Lin-Weiss-Bisceglia标准。免疫组织化学标记（Calretinin，α-抑制素,MelanA,SF-1，Ki-67，PHH3，IGF-2，β-连环蛋白，P53，CYP11B1，CYP11B2，MLH1，MSH2，MSH6，PMS2，EPCAM）和Gomori银组织化学。统计分析利用SPSS统计26。
结果：与ACA相比，ACC表现出更大的肿瘤大小（P<0.001）和症状表现（P=0.031）。改良的Weiss标准和血管浸润的参数证明了对ACCs的诊断价值。六种免疫组织化学抗体（（MelanA，Ki-67，IGF-2，β-catenin，P53和CYP11B1）和网织蛋白骨架改变显示出诊断价值。值得注意的是,最推荐Ki-67和网织蛋白染色。ACCs中经常出现明显的网织蛋白染色（P<0.001）。Ki-67在ACCs中显著增高(P<0.001)。21个常规和7个嗜酸细胞实体显示不同的坏死频率。症状和Ki-67指数≥30%是ACCs的预后，与较短的生存有关。
结论：本研究强调了网状蛋白骨架改变和高Ki-67指数的诊断价值。CYP11B1、IGF2、P53、β-联蛋白和黑色素A等标志物也有助于ACCs的诊断。症状和Ki-67指数≥30%预测生存期较短。这些发现鼓励在肾上腺皮质肿瘤的评估中使用辅助标记，例如网状蛋白组织化学和Ki-67。
方法：为了评估临床病理特征的诊断和预后效用，形态学,辅助生物标志物，和肾上腺皮质肿瘤的网状组织化学。我们检查了从病理档案中获得的28例肾上腺皮质癌（ACC）和50例肾上腺皮质腺瘤（ACA）。从医疗记录中检索临床数据。两名病理学家独立评估了苏木精和伊红染色的载玻片，对所有肿瘤采用改良的Weiss标准，对嗜酸细胞变异体采用Lin-Weiss-Bisceglia标准。免疫组织化学标记（Calretinin，α-抑制素,MelanA,SF-1，Ki-67，PHH3，IGF-2，β-连环蛋白，P53，CYP11B1，CYP11B2，MLH1，MSH2，MSH6，PMS2，EPCAM）和Gomori银组织化学。统计分析利用SPSS统计26。
结果：与ACA相比，ACC表现出更大的肿瘤大小（P<0.001）和症状表现（P=0.031）。改良的Weiss标准和血管浸润的参数证明了对ACCs的诊断价值。六种免疫组织化学抗体（（MelanA，Ki-67，IGF-2，β-catenin，P53和CYP11B1）和网织蛋白骨架改变显示出诊断价值。值得注意的是,最推荐Ki-67和网织蛋白染色。ACCs中经常出现明显的网织蛋白染色（P<0.001）。Ki-67在ACCs中显著增高(P<0.001)。21个常规和7个嗜酸细胞实体显示不同的坏死频率。症状和Ki-67指数≥30%是ACCs的预后，与较短的生存有关。
结论：本研究强调了网状蛋白骨架改变和高Ki-67指数的诊断价值。CYP11B1、IGF2、P53、β-联蛋白和黑色素A等标志物也有助于ACCs的诊断。症状和Ki-67指数≥30%预测生存期较短。这些发现鼓励在肾上腺皮质肿瘤的评估中使用辅助标记，例如网状蛋白组织化学和Ki-67。
