Morphological and clinical characteristics of patients with adrenocortical carcinoma

Monika Ciupińska-Kajor; Jacek Ziaja; Maciej Kajor; Robert Król; Zuzanna Dobrosz; Piotr Konicki; Kornelia Hasse-Lazar; Teresa Gasińska; Lech Cierpka

Vol 8, No 2 (2006)

Published online: 2006-04-12

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Morphological and clinical characteristics of patients with adrenocortical carcinoma

Monika Ciupińska-Kajor, Jacek Ziaja, Maciej Kajor, Robert Król, Zuzanna Dobrosz, Piotr Konicki, Kornelia Hasse-Lazar, Teresa Gasińska, Lech Cierpka

Chirurgia Polska 2006;8(2):146-155.

Vol 8, No 2 (2006)

Published online: 2006-04-12

Abstract

Background: Adrenocortical carcinoma is a rare neoplasm. The clinical symptoms of adrenal cancer in about 50% of cases result from endocrine activity. Hormonally inactive adrenal cancers are usually found incidentally or when they cause local clinical symptoms. The aim of this study was to compare the results of pathological examination with the stages of neoplasm observed during intraoperative examination as well as the further course of the disease in patients with adrenocortical carcinoma.
Material and methods: Seven patients subjected to an adrenalectomy for an adrenal tumour after which a postoperative pathological examination revealed adrenal cancer were analysed. Histologically tumours were analysed according to the Weiss scale. The stage of the disease was classified according to the TNM and MacFarlane scales.
Results: In 2 patients symptoms of endocrine hyperactivity were observed, in 3, uncharacteristic abdominal pain while in 2, the tumour was diagnosed accidentally. In 2 patients local disease was diagnosed (T2, N0, M0; MacFarlane stage II), in 4, regional (T4, N1, M0; MacFarlane stage III), in 1, metastatic (T4, N1, M0; MacFarlane stage IV). In 1 patient 4 features of malignancy according to the Weiss scale were observed, while in the remaining patients, the number of features was 7 to 9. Poor prognostic factors, such as mitoses > 5/50 HPF were observed in all cases, atypical mitoses in 6, necrosis in 5, venous infiltration in 5, capsular infiltration in 5. The follow-up period was 3 to 44 months. In 2 patients no features of recurrence were observed, in remaining 5 there was local recurrence, dissemination of the disease and as a consequence, death.
Conclusions: Adrenocortical carcinoma is a tumour of high malignancy, diagnosed usually in advanced stage, which results in a poor prognosis for patients suffering from this disease.