Blanes and Diaz-Cano developed an algorithm for distinguishing the various types of adrenocortical proliferative lesions based on histopathologic features. The authors are from the University Hospital Malaga (Spain) and King's College (London).
Exclusion: tumors of the adrenal medulla, metastatic carcinoma
Parameters:
(1) mitotic activity in 50 high power fields (HPF)
(2) anisokaryosis
(3) nuclear grade
(4) growth pattern
(5) tissue reaction
(6) hyperplasia in adjacent adrenal gland
|
Mitotic Activity |
Aniso-karyosis |
Nuclear Grade |
Growth Pattern |
Tissue Reaction |
Adjacent Adrenal |
Pattern |
|
<= 2 |
Y |
|
|
|
not hyper-plastic |
A |
|
<= 2 |
Y |
|
|
|
hyper-plastic |
B |
|
<= 2 |
N |
|
|
|
|
C |
|
2 - 5 |
N |
low |
|
|
|
D |
|
2 - 5 |
Y |
low |
|
|
|
E |
|
2 - 5 |
|
high |
not diffuse |
myxoid |
|
F |
|
2 - 5 |
|
high |
not diffuse |
desmo-plastic |
|
G |
|
2 - 5 |
|
high |
diffuse |
|
|
H |
|
> 5 |
|
|
|
|
|
I |
where:
• A desmoplastic tissue reaction showed homogeneous, hyaline connective tissue. A myxoid reaction showed a basophilic loose extracellular matrix.
• The area of 50 high powered fields is 5.232 square mm.
|
Pattern |
Diagnosis |
|
A |
adenoma |
|
B |
nodular hyperplasia |
|
C |
nodular hyperplasia |
|
D |
nodular hyperplasia |
|
E |
adenoma |
|
F |
adenoma |
|
G |
carcinoma |
|
H |
carcinoma |
|
I |
carcinoma |
Specialty: Hematology Oncology, Surgery, general, Endocrinology
ICD-10: ,
