Clinical characteristics and follow-up of incidentally found adrenal tumours — results from a single tertiary centre

Васильев, В. Н.; Matrozova, Joanna; Еленкова, Атанаска; Zacharieva, Sabina

doi:10.2478/s11536-013-0199-9

Cited by 2 publications

(1 citation statement)

References 49 publications

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“…We observed a similar relation, but not significant (p=0.072). Vasilev et al observed that NFAs are smaller than CPAs, and similar in size to APAs, which is in complete opposition to our results (20). In the combined group of all the examined AGTs, the tumors of younger patients had smaller volume (p=0.025).…”

Section: Discussioncontrasting

confidence: 99%

Minichromosome Maintenance Proteins MCM-3, MCM-5, MCM-7, and Ki-67 as Proliferative Markers in Adrenocortical Tumors

et al. 2019

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Background/Aim: Morphological features, combined with Ki-67 proliferative index, remain the standard for discriminating benign and malignant adrenocortical tumors. The aim of this study was to evaluate the role of minichromosome maintenance proteins MCM-3, MCM-5, MCM-7, and Ki-67 as proliferative markers in adrenocortical tumors. Materials and Methods: Specimens of 81 adrenocortical adenomas and 3 adrenocortical carcinomas were stained with antibodies against MCM-3, 5, 7 and Ki-67. Results: Malignant tumors were characterized by a greater size (p=0.017), volume (p=0.017), and higher levels of Ki-67 (p=0.005), MCM-3 (p=0.005), MCM-7 (p=0.008), but not MCM-5 (p=0.069). The markers' levels were independent from the tumors' size and volume, the patient's age and hormonal status. ROC curves showed Ki-67 (AUC 0.984), MCM-3 (AUC 0.984), and MCM-7 (AUC 0.950), but not MCM-5 (AUC 0.820) to be reliable markers. Conclusion: Ki-67, MCM-3, and MCM-7, but not MCM-5 are reliable proliferative and diagnostic markers in discerning benign and malignant adrenocortical tumors. Adrenal gland tumors (AGTs) are relatively common and constitute 5-9% of all human tumors. The greater accessibility to diagnostic imaging in recent years, especially ultrasound (US) and computed tomography (CT), has revealed that the rate of AGTs is significantly higher than previously reported. The prevalence of incidentally detected adrenal mass (socalled incidentaloma) is greater with age and ranges from 0.2% (20-29 years old) to 3% (over 50 years of age) and even up to 7% (over 70 years of age) (1, 2). The mean value for the general population is about 2-4% (3, 4). An incidentaloma is typically detected in the right adrenal gland, between the 5th and 7th decade of life (mean age 55 years). AGTs are found on average in 1-8.9% (mean 2.3%) of autopsies, and even in as high as 15% according to some authors (2, 4). Apart from an incidentaloma, adrenal tumors may present symptoms, either of hormonal excess or a mass effect (5). Following the finding of an AGT, steps are taken to determine its origin (cortical/medullar) and character (benign/malignant) (1, 3, 6). Most AGTs are of cortical origin and benign, adrenocortical adenoma (ACA) is the most frequent diagnosis (70-94%) (2, 5). The majority of ACAs do not display hormonal activity. The most common functioning ACA is aldosterone-producing adenoma (APA), followed by cortisol-producing adenoma (CPA) (7). A malignant AGT can be either a primary adrenal lesion or a metastasis (3). Primary malignancies consist of cortical (adrenocortical carcinoma-ACC) and medullar lesions (malignant pheochromocytomaabout 10% (2.5-26%) of all pheochromocytomas) (6). Metastatic AGTs vary in origin, including lung, renal, breast, gastrointestinal (gastric, colorectal), hepatocellular carcinoma and melanoma (1, 3, 5, 8). The presence of an extra-adrenal primary malignancy increases significantly the odds of an 1151 This article is freely accessible online.

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Section: Discussioncontrasting

confidence: 99%