Oncocytic adrenocortical carcinomas: A pathological and immunohistochemical study of four cases in comparison with conventional adrenocortical carcinomas

Abstract

Clinicopathological features of four cases of oncocytic adrenocortical carcinomas were studied. All tumors were large, circumscribed tumors with average size and weight of 11.5 cm and 586 g, respectively. The cut surfaces were yellow or brown and tan with areas of hemorrhage, necrosis, fibrosis, myxoid and cystic change. The tumor cells were exclusively oncocytic with a diffuse or compact and solid arrangement. Nuclear atypia was identified but mitosis was rare. Capsular invasion was identified in all tumors and vascular invasion was identified in one tumor. All tumors were immunoreactive for vimentin and inhibins. Immunoreactivity for pancytokeratin, synaptophysin and S-100 protein was variable and focal. All tumors had low proliferative indices, of less than 1%, and were negative for p53 protein. Ultrastructurally, the cytoplasm of tumor cells showed numerous mitochondria in a compact arrangement. Oncocytic adrenocortical carcinomas showed a similar sex ratio, slightly older mean age, similar left predilection, slightly smaller size and lighter weight compared with the conventional carcinomas. We suggest that most oncocytic adrenocortical carcinomas might be low-grade malignancies with less aggressive histological features compared with conventional carcinomas. However, they should be excised completely because of the likelihood of recurrence and metastasis during the follow-up period.

Adrenal Oncocytic Neoplasm: A Systematic Review

“…According to the currently used classification, there are three histological categories: pure and benign oncocytoma, oncocytic neoplasm of uncertain malignant potential [36][37][38] and oncocytic carcinoma [39][40][41][42] .…”

Functional Oncocytic Adrenocortical Carcinoma

“…The most important practical problem regarding oncocytic adrenocortical carcinomas concerns their biological behavior, that is their distinction form adrenocortical oncocytomas [2,3,9]. According to the Weiss criteria of malignancy for adrenocortical tumors, there are nine pathological findings: high nuclear grade (Fuhrman III or IV), less than 25% clear cells, diffuse architecture, tumor necrosis, five or more mitotic figures/50 HPF, atypical mitoses, capsular invasion, venous invasion, and sinusoidal invasion that can help define malignancy [12,13].…”

Oncocytome de la surrénale : Étude de cas

“…En 1989, Weiss et al ont proposé neuf critères histologiques permettant de faire la distinction entre les tumeurs bénignes et malignes 7 . Ces critères sont représentés par le grade nucléaire de Führman, le nombre de mitoses par 50 champs au fort grossissement, la présence de mitoses atypiques et 3,4 . Notre cas est considéré comme bénin selon cette dernière classification.…”