Adrenocortical Oncocytic Tumors: Report of 10 Cases and Review of the Literature

International Journal of Surgical Pathology - Tập 12 Số 3 - Trang 231-243 - 2004
Michele Bisceglia1, Ornella Ludovico2, Antonio Di Mattia3, David Ben‐Dor4, Judith Sandbank5, Gianandrea Pasquinelli6, Sean K. Lau7, Lawrence M. Weiss7
1Department of Pathology, IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo (FG), Italy
2Department of Operative Unit of Endocrinology, IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo (FG), Italy
3Division of General Surgery, “Umberto I” Hospital, San Marco in Lamis (FG), Italy
4Department of Pathology, Barzilai Medical Center, Ben-Gurion University, Ashkelon, Israel
5Department of Pathology, Asaf Harofe Hospital, Zerifin, Israel
6Department of Pathology, IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo (FG), Italy, Department of Experimental Pathology, Clinical Pathology Section, Policlinico “S. Orsola”, Bologna, Italy
7Department of Pathology, City of Hope National Medical Center, Duarte, California, USA

Tóm tắt

Ten additional adrenocortical oncocytic tumors are presented: 2 benign oncocytomas, 4 borderline oncocytomas of uncertain malignant potential, and 4 oncocytic carcinomas. Histologically all tumors were entirely or predominantly composed of oncocytes. Immunohistochemically all tumors were immunoreactive for mitochondrial antigen mES-13. Electron microscopy was performed in 8 cases and was confirmatory of the oncocytic cell change. The morphologic parameters of the Weiss system, considered to be predictive of the biologic behavior of conventional (nononcocytic) adrenocortical tumors, are reviewed in the context of their possible application to the oncocytic tumor variant. Proposed major criteria (high mitotic rate, atypical mitoses, venous invasion) and minor criteria (large size and huge weight, necrosis, capsular invasion, sinusoidal invasion) in distinguishing malignant tumors are discussed, and definitional criteria (predominantly cells with eosinophilic and granular cytoplasm, high nuclear grade, diffuse architectural pattern) in common with all types of oncocytic tumors are outlined. The authors’ proposed working rules for diagnostic categorization of oncocytic adrenocortical tumors are defined, with the presence of 1 major criterion indicating malignancy, 1 to 4 minor criteria indicating uncertain malignant potential (borderline), and the absence of all major and minor criteria indicative of benignancy. Using these criteria, the diagnosis of malignancy was straightforward in 3 of the 4 cases designated as oncocytic carcinoma (presence of at least 2 major criteria and all the minor criteria), while in 1 case the original diagnosis of benign oncocytoma was reversed to malignant following critical review of the original pathologic material after local tumor recurrence. Tumor recurrence occurred in 2 carcinomas at 8 and 20 months, respectively, and was followed in 1 case by the patient’s death. The third patient expired at 6 months from unrelated causes, and the fourth patient is free of disease at the relatively short follow-up interval of 6 months. Regarding the 4 patients with borderline tumors, all are alive with no evidence of disease, with follow-up ranging from 10 to 61 months (mean 38.7 months). The 2 benign tumors have a follow-up of 25 and 30 months, respectively. Diagnostic difficulties are delineated and a complete review of the literature on this topic has also been performed.

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International Journal of Surgical Pathology

Tập 12 Số 3

231-243

Thông tin tác giả