The Weiss Score and Beyond-Histopathology for Adrenocortical Carcinoma

被引：85
作者：
Papotti M. [1 ]
Libè R. [2 ,3 ]
Duregon E. [1 ]
Volante M. [1 ]
Bertherat J. [2 ,3 ]
Tissier F. [3 ,4 ]
机构：
[1] Department of Clinical and Biological Sciences, University of Turin at San Luigi Hospital, 10043 Orbassano, Turin
[2] AP-HP, Service des maladies endocriniennes et métaboliques, Hôpital Cochin, Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris
[3] INSERM U1016 et CNRS UMR8104, Institut Cochin, Département Endocrinologie Métabolisme et Cancer, Réseau COMETE, Paris
[4] AP-HP, Service d'Anatomie Pathologique, Hôpital Cochin, Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris
来源：
Hormones and Cancer | 2011年 / 2卷 / 6期
关键词：
Adrenocortical carcinoma; Diagnostic algorithm; Morphological variants; Weiss scoring system;
D O I：
10.1007/s12672-011-0088-0
中图分类号：
学科分类号：
摘要：
The pathological diagnosis of adrenocortical carcinoma (ACC) is still challenging for its rarity and the presence of special variants (pediatric, oncocytic, myxoid, and sarcomatoid). It is based on the recognition at light microscopy of at least three among nine morphological parameters, according to the Weiss scoring system, which has been introduced 27 years ago and nowadays is the most widely employed. Nevertheless, the diagnostic performance of this system is very high but does not reach a sensitivity and specificity of 100%, its diagnostic applicability is potentially low among non-expert pathologists, and a group of borderline cases with only one or two criteria exist of uncertain behavior. Moreover, it is scarcely reproducible in the ACC morphological variants. In fact, specifically for the pure oncocytic neoplasms that seem to have a better prognosis in comparison to the conventional ACCs, a modified system (the Lin-Weiss-Bisceglia) has been proposed. With the aim to simplify the ACC diagnosis, 2 years ago, the "reticulin" diagnostic algorithm has been proposed, based on the observation that the tumoral reticulin framework (highlighted by reticulin silver-based histochemical staining) is consistently disrupted in malignant cases but only in a small subset of benign cases. Following this algorithm, in the presence of reticulin alterations, malignancy is further defined through the identification of at least one of the following parameters: necrosis, high mitotic rate, and venous invasion. As a complement to the morphological approach, some immunohistochemical markers (such as steroidogenic factor 1) have been proposed as diagnostic and prognostic adjuncts but still lack wide clinical validation. © 2011 Springer Science+Business Media, LLC.
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页码：333 / 340
页数：7
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