Adrenal gland & paraganglia

General

Features to report-adrenal cortical carcinoma



Last author update: 2 January 2019
Last staff update: 31 January 2024 (update in progress)

Copyright: 2002-2024, PathologyOutlines.com, Inc.

PubMed Search: Adrenocortical carcinoma pathology features to report

Debra L. Zynger, M.D.
Page views in 2023: 1,373
Page views in 2024 to date: 206
Cite this page: Zynger D. Features to report-adrenal cortical carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/adrenalreportadrenalcarcinoma.html. Accessed March 19th, 2024.
Weiss criteria
  • Weiss criteria can be evaluated to determine malignant potential:
    • High nuclear grade
    • Mitotic rate > 5 mitoses per 50 high powered (40x) fields
    • Atypical mitotic figures
    • < 25% clear cells
    • Diffuse architecture
    • Necrosis
    • Venous invasion
    • Sinusoidal invasion
    • Capsular invasion
  • Reference: Am J Surg Pathol 1984;8:163
Required features to report
  • If malignancy is established, the following items are required to be reported per the CAP Protocol for the Examination of Specimens From Patients With Carcinoma of the Adrenal Gland:
    • Procedure
    • Laterality
    • Size (greatest dimension)
    • Weight
    • Histologic type (oncocytic, myxoid, sarcomatoid)
    • Grade (low grade if 20 or fewer mitoses per 50 high powered [40x] fields; high grade if > 20 mitoses per 50 high powered fields)
    • Lymphovascular invasion
    • Tumor extent (into capsule, extra-adrenal tissue or adjacent organs)
    • Margins
    • Regional lymph node status
    • Distant metastasis (if applicable)
    • pTNM stage
  • The following items are necessary to establish the 8th edition AJCC pTNM stage:
    • Size (5 cm or less or > 5 cm)
    • Tumor extent (into extra-adrenal tissue or adjacent organs, renal vein or vena cava)
    • Regional lymph node status
    • Distant metastasis (if applicable)
  • References: CAP: Protocol for the Examination of Specimens From Patients With Carcinoma of the Adrenal Gland [Accessed 30 November 2022], Amin: AJCC Cancer Staging Manual, 8th Edition, 2017
Microscopic (histologic) images

Contributed by Debra Zynger, M.D. and Maria Tretiakova, M.D., Ph.D.
Extra-adrenal adipose invasion (pT3)

Extra-adrenal adipose invasion (pT3)

High mitotic rate

High mitotic rate

Lymphovascular invasion

Lymphovascular invasion

Myxoid variant

Myxoid variant

Oncocytic variant

Oncocytic variant

Liver involvement (pT4)

Liver involvement (pT4)


Transition to myxoid area

Transition to myxoid area

Myxoid variant

Myxoid variant

Extra-adrenal adipose invasion (pT3)

Extra-adrenal adipose invasion (pT3)

Fat invasion & positive margin

Positive margin

Regional node involvement

Regional node involvement (pN1)

Back to top
Image 01 Image 02