Adrenocortical tumors were evaluated using 7 histologic criteria and several nonhistologic criteria which were found statistically significant in predicting subsequent metastases. No single criterion can be used alone for diagnosing carcinoma.
Nonhistologic criteria:
(1) weight loss
(2) endocrine functionality
(3) tumor weight
(4) urinary 17-ketosteroid excretion
(5) response to ACTH stimulation
Histologic Criteria
|
Criterion |
Definition |
Points |
|
growth pattern |
not diffuse |
0 |
|
|
diffuse (growth of cells in sheets without organization into trabeculae or alveolae) |
0.92 |
|
vascular invasion |
absent |
0 |
|
|
presence of tumor cells within lumina of blood vessels |
0.92 |
|
tumor cell necrosis |
absent or local if isolated 1 high powered (400x) field in diameter present |
0 |
|
|
widespread (present) if areas 2 high powered fields in diameter present |
0.69 |
|
broad fibrous bands |
absent |
0 |
|
|
presence of any fibrous connective tissue septae >= 1 high powered field in diameter |
1.00 |
|
capsular invasion |
absent |
0 |
|
|
nests of tumor cells present in the capsule |
0.37 |
|
mitotic index |
< 1 |
0 |
|
|
>= 1 |
0.60 |
|
pleomorphism |
absent |
0 |
|
|
hyperchromatic nuclei with high nuclear-cytoplasmic ratio, marked variation in nuclear characteristics; tumor giant cells with hyperchromatic nuclei |
0.39 |
where:
• mitotic index = (number of mitoses in 100 high powered fields) divided by 10
• the value assigned to positive finding are based on the Bayesian probability that metastases will be associated with a given histologic parameter, with the value assigned = log (1 / (1 - (Bayesian probability)))
histologic index of malignancy =
= SUM (values for criteria present)
Interpretation:
• minimum histologic index 0
• maximum histologic index 4.89
• benign tumors had index with mean 0.17 and standard deviation 0.26
• indeterminate tumors had index with mean 1.00 and standard deviation of 0.58
• malignant tumors had index with mean 2.91 with standard deviation of 0.90
Specialty: Hematology Oncology, Surgery, general, Endocrinology
ICD-10: ,
