51
|
Abstract
Adrenocortical carcinomas are rare tumours that can be diagnostically challenging. Numerous multiparametric scoring systems and diagnostic algorithms have been proposed to differentiate adrenocortical adenoma from adrenocortical carcinoma. Adrenocortical neoplasms must also be differentiated from other primary adrenal tumours, such as phaeochromocytoma and unusual primary adrenal tumours, as well as metastases to the adrenal gland. Myxoid, oncocytic and sarcomatoid variants of adrenocortical tumours must be recognized so that they are not confused with other tumours. The diagnostic criteria for oncocytic adrenocortical carcinoma are different from those for conventional adrenocortical carcinomas. Adrenocortical neoplasms in children are particularly challenging to diagnose, as histological features of malignancy in adrenocortical neoplasms in adults may not be associated with aggressive disease in the tumours of children. Recent histological and immunohistochemical studies and more comprehensive and integrated genomic characterizations continue to advance our understanding of the tumorigenesis of these aggressive neoplasms, and may provide additional diagnostic and prognostic utility and guide the development of therapeutic targets.
Collapse
Affiliation(s)
- Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
52
|
Mastellaro MJ, Ribeiro RC, Oliveira‐Filho AG, Seidinger AL, Cardinalli IA, Miranda EC, Aguiar SS, Brandalise SR, Yunes JA, Barros‐Filho AA. Adrenocortical tumors associated with the TP53 p.R337H germline mutation can be identified during child‐care consultations. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
53
|
Mastellaro MJ, Ribeiro RC, Oliveira-Filho AG, Seidinger AL, Cardinalli IA, Miranda ECM, Aguiar SS, Brandalise SR, Yunes JA, Barros-Filho AA. Adrenocortical tumors associated with the TP53 p.R337H germline mutation can be identified during child-care consultations. J Pediatr (Rio J) 2018; 94:432-439. [PMID: 28864397 DOI: 10.1016/j.jped.2017.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/17/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To evaluate the clinical features associated with adrenocortical hormone overexpression and familial cancer profiling as potential markers for early detection of adrenocortical tumors in children from South and Southeast Brazil. METHODS The clinical manifestations and anthropometric measurements of 103 children diagnosed with adrenocortical tumors were analyzed. RESULTS Between 1982 and 2011, 69 girls and 34 boys diagnosed with adrenocortical tumors were followed-up for a median time of 9.0 years (0-34 years). Signs of androgen overproduction alone (n=75) or associated with cortisol (n=18) were present in 90.3%. TP53 p.R337H mutation was found in 90.5% of patients. Stages I, II, III, and IV were observed in 45.6%, 27.2%, 19.4%, and 7.8% of patients, respectively. At diagnosis, there were no significant differences in height (p=0.92) and weight (p=0.22) among children with adrenocortical tumors, but children with virilization alone had significantly higher height-for-age Z-scores (0.92±1.4) than children with hypercortisolism alone or combined (-0.32±1,8; p=0.03). The five-year overall survival was 76.7% (SD±4.2). Patients with advanced-stage disease had a significantly worse prognosis than those with limited disease (p<0.001). During follow-up, ten of 55 p.R337H carrier parents developed cancer, whereas none of the 55 non-carriers did. CONCLUSIONS Signs of adrenocortical hormone overproduction appear early, even in cases with early-stage. These signs can be identified at the physical examination and anthropometric measurements. In southern Brazil, pediatric adrenocortical tumor is a sentinel cancer for detecting families with germline p.R337H mutation in TP53 gene.
Collapse
Affiliation(s)
- Maria J Mastellaro
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Programa de Pós-Graduação em Saúde Infantil e do Adolescente, Campinas, SP, Brazil; Centro Infantil Boldrini, Departamento de Oncologia, Campinas, SP, Brazil.
| | - Raul C Ribeiro
- St. Jude Children's Research Hospital, Department of Global Medicine, International Outreach Program and Department of Oncology, Memphis, United States; Instituto Pelé Pequeno Príncipe, Programa de Pós-Graduação em Saúde Infantil e do Adolescente, Curitiba, PR, Brazil
| | - Antônio G Oliveira-Filho
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brazil
| | - Ana L Seidinger
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Genética Médica, Campinas, SP, Brazil; Centro Infantil Boldrini, Laboratório de Biologia Molecular, Campinas, SP, Brazil
| | | | - Eliana C M Miranda
- Universidade Estadual de Campinas (UNICAMP), Centro de Dados e Estatística, Departamento de Hematologia e Hemoterapia, Campinas, SP, Brazil
| | - Simone S Aguiar
- Centro Infantil Boldrini, Departamento de Oncologia, Campinas, SP, Brazil; Universidade Estadual de Campinas (UNICAMP), Centro de Pesquisa em Pediatria (CIPED), Campinas, SP, Brazil
| | - Silvia R Brandalise
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil; Centro Infantil Boldrini, Departamento de Oncologia e Hematologia, Campinas, SP, Brazil
| | - José A Yunes
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Genética Médica, Campinas, SP, Brazil; Centro Infantil Boldrini, Laboratório de Biologia Molecular, Campinas, SP, Brazil
| | - Antônio A Barros-Filho
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil
| |
Collapse
|
54
|
Abstract
Cushing syndrome (CS) is a multisystem disorder resulting from the prolonged exposure to excess glucocorticoids. In children, CS most commonly results from the exogenous administration of steroids and the typical presentation is height deceleration concomitant with weight gain. Endogenous and ectopic causes are rare. CS in children may be associated with distinct germline and somatic mutations. Clinical practice guidelines are available assist clinicians. Patients should be referred to multidisciplinary centers of excellence with experience in endocrinology and surgery. Early detection and treatment is essential to reduce associated acute and long-term morbidity and potential death.
Collapse
Affiliation(s)
- Maya B Lodish
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), NIH-Clinical Research Center, 10 Center Drive, Building 10, Room 1E-3330, MSC1103, Bethesda, MD 20892, USA
| | - Margaret F Keil
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), NIH-Clinical Research Center, 10 Center Drive, Building 10, Room 1E-3330, MSC1103, Bethesda, MD 20892, USA.
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), NIH-Clinical Research Center, 10 Center Drive, Building 10, Room 1E-3330, MSC1103, Bethesda, MD 20892, USA
| |
Collapse
|
55
|
Stratakis CA. An update on Cushing syndrome in pediatrics. ANNALES D'ENDOCRINOLOGIE 2018; 79:125-131. [DOI: 10.1016/j.ando.2018.03.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
56
|
Pinheiro C, Granja S, Longatto-Filho A, Faria AM, Fragoso MCBV, Lovisolo SM, Bonatelli M, Costa RFA, Lerário AM, Almeida MQ, Baltazar F, Zerbini MCN. GLUT1 expression in pediatric adrenocortical tumors: a promising candidate to predict clinical behavior. Oncotarget 2017; 8:63835-63845. [PMID: 28969033 PMCID: PMC5609965 DOI: 10.18632/oncotarget.19135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 06/12/2017] [Indexed: 12/20/2022] Open
Abstract
Background Discrimination between benign and malignant tumors is a challenging process in pediatric adrenocortical tumors. New insights in the metabolic profile of pediatric adrenocortical tumors may contribute to this distinction, predict prognosis, as well as identify new molecular targets for therapy. The aim of this work is to characterize the expression of the metabolism-related proteins MCT1, MCT2, MCT4, CD147, CD44, GLUT1 and CAIX in a series of pediatric adrenocortical tumors. Methods A total of 50 pediatric patients presenting adrenocortical tumors, including 41 clinically benign and 9 clinically malignant tumors, were included. Protein expression was evaluated using immunohistochemistry in samples arranged in tissue microarrays. Results The immunohistochemical analysis showed a significant increase in plasma membrane expression of GLUT1 in malignant lesions, when compared to benign lesions (p=0.004), being the expression of this protein associated with shorter overall and disease-free survival (p=0.004 and p=0.001, respectively). Although significant differences were not observed for proteins other than GLUT1, MCT1, MCT4 and CD147 were highly expressed in pediatric adrenocortical neoplasias (around 90%). Conclusion GLUT1 expression was differentially expressed in pediatric adrenocortical tumors, with higher expression in clinically malignant tumors, and associated with shorter survival, suggesting a metabolic remodeling towards a hyperglycolytic phenotype in this malignancy.
Collapse
Affiliation(s)
- Céline Pinheiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Barretos School of Health Sciences Dr. Paulo Prata - FACISB, São Paulo, Brazil.,Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo, Brazil
| | - Sara Granja
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Adhemar Longatto-Filho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo, Brazil.,Laboratory of Medical Investigation (LIM-14), School of Medicina, University of São Paulo, São Paulo, Brazil
| | - André M Faria
- Unidade de Suprarrenal, Disciplina de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular LIM42, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria C B V Fragoso
- Unidade de Suprarrenal, Disciplina de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular LIM42, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto do Câncer do Estado de São Paulo - ICESP, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Silvana M Lovisolo
- Hospital Universitário, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Murilo Bonatelli
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo, Brazil
| | - Ricardo F A Costa
- Barretos School of Health Sciences Dr. Paulo Prata - FACISB, São Paulo, Brazil
| | - Antonio M Lerário
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Madson Q Almeida
- Unidade de Suprarrenal, Disciplina de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular LIM42, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto do Câncer do Estado de São Paulo - ICESP, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fátima Baltazar
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Maria C N Zerbini
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
57
|
Malhotra S, Waikar AR, Singh P, Guarini L, Jacobson-Dickman E, Motaghedi R, Kazachkova I. Rare Presentation of Adrenocortical Carcinoma in a 4-Month-Old Boy. World J Oncol 2017; 8:81-85. [PMID: 29147440 PMCID: PMC5650002 DOI: 10.14740/wjon1036w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2017] [Indexed: 11/24/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare malignancy and even rarer in infancy. Most of these tumors in pediatric age group are hormonally active and predominantly present with virilization. Cortisol hypersecretion presenting as Cushing syndrome is extremely rare and seen in older age groups. We report a 4-month-old infant who presented with linear growth arrest and excessive weight gain in early infancy, consequently diagnosed with ACC. On long-term follow-up for 7 years, he remained metastasis free following surgical resection and was not treated with chemotherapy.
Collapse
Affiliation(s)
- Sonali Malhotra
- Department of Pediatric Endocrinology, Infant and Children's Hospital of Brooklyn, Maimonides Medical Center, Brooklyn, NY, USA
| | - Apoorva R Waikar
- Department of Pediatrics, Brooklyn Hospital Center, Brooklyn, NY, USA
| | | | - Ludovico Guarini
- Department of Pediatric Hematology Oncology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Elka Jacobson-Dickman
- Department of Pediatric Endocrinology, Infant and Children's Hospital of Brooklyn, Maimonides Medical Center, Brooklyn, NY, USA
| | - Roja Motaghedi
- Department of Pediatric Endocrinology, Infant and Children's Hospital of Brooklyn, Maimonides Medical Center, Brooklyn, NY, USA
| | - Irina Kazachkova
- Department of Pediatric Endocrinology, Infant and Children's Hospital of Brooklyn, Maimonides Medical Center, Brooklyn, NY, USA
| |
Collapse
|
58
|
Cecchetto G, Ganarin A, Bien E, Vorwerk P, Bisogno G, Godzinski J, Dall'Igna P, Reguerre Y, Schneider D, Brugières L, Leblond P, Ferrari A, Brecht I, De Paoli A, Orbach D. Outcome and prognostic factors in high-risk childhood adrenocortical carcinomas: A report from the European Cooperative Study Group on Pediatric Rare Tumors (EXPeRT). Pediatr Blood Cancer 2017; 64. [PMID: 27957799 DOI: 10.1002/pbc.26368] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/14/2016] [Accepted: 10/24/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The aim of this retrospective international analysis was to evaluate the role of risk factors in pediatric patients with adrenocortical carcinoma (ACC) observed in European countries (2000-2013) in an attempt to identify factors associated with poor prognosis. PROCEDURES Data were retrieved from databases of Germany, France, Poland, and Italy, which form the European Cooperative Study Group on Pediatric Rare Tumors (EXPeRT). Patients were less than 18 years old, with at least one of the following tumor-related risk factors: metastases, volume more than 200 cm3 , Cushing syndrome, vascular or regional lymph node invasion, initial biopsy, or incomplete excision. Role of patients' age was also evaluated. RESULTS Eighty-two patients were evaluated: 62 with localized disease and 20 with metastases. The 3-year progression-free survival (PFS) and overall survival (OS) were 39% and 55% for the whole population, respectively, and 51% and 73% for localized diseases, respectively. Concerning the whole population, PFS and OS were influenced by distant metastases, tumor volume, lymph node involvement, age, and presence of two or more risk factors. Factors significant only at OS were vascular involvement and incomplete surgery. At multivariable analysis, the main factors at PFS were volume more than 200 cm3 (hazard ratio [HR]: 2.6, 95% confidence interval [CI]: 1.18-5.70) and presence of distant metastases (HR: 8.26, 95% CI: 3.49-19.51). The OS was significantly influenced by the presence of metastases (P < 0.0001). Concerning patients with localized tumors, the only significant prognostic factor was volume more than 200 cm3 with a HR of 4.38 (95% CI: 1.60-12.00) for PFS and of 3.68 (95% CI: 1.02-13.30) for OS. CONCLUSIONS Distant metastases and large tumor volume were the main unfavorable prognostic factors. Presence of two or more factors related to ACC was associated with an aggressive behavior of disease.
Collapse
Affiliation(s)
- Giovanni Cecchetto
- Pediatric Surgery Unit, Department of Woman's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Alba Ganarin
- Pediatric Surgery Unit, Department of Woman's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Ewa Bien
- Department of Pediatrics, Medical University, Gdansk, Poland
| | - Peter Vorwerk
- Pediatric Oncology Department, Otto von Guericke University Children's Hospital, Magdeburg, Germany
| | - Gianni Bisogno
- Pediatric Hematology-Oncology Unit, Department of Woman's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Jan Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw, Poland
| | - Patrizia Dall'Igna
- Pediatric Surgery Unit, Department of Woman's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Yves Reguerre
- Oncology and Hematology Unit, French Pediatric Rare Tumor Group (groupe Fracture), CHU de Saint Denis de La Réunion., Saint Denis, France
| | - Dominik Schneider
- Clinic of Pediatrics, Municipal Hospital Dortmund, Dortmund, Germany
| | | | - Pierre Leblond
- Pediatric Department, Centre Oscar Lambret, Lille, France
| | - Andrea Ferrari
- Fondazione IRCCS Istituto Nazionale Tumori Milano, Milan, Italy
| | - Ines Brecht
- University Children's Hospital, Erlangen, Germany
| | - Angela De Paoli
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padua, Italy
| | - Daniel Orbach
- Department of Pediatric, Adolescent, Young Adult Oncology, French Pediatric Rare Tumor group (groupe Fracture), Institut Curie, Paris, France
| |
Collapse
|
59
|
Ru W, Yang M, Xu S, Li M, Tang D. Management and prognosis of adrenocortical tumors in children: can we find out an appropriate points-scoring system to predict prognosis? Pediatr Surg Int 2017; 33:705-711. [PMID: 28260193 DOI: 10.1007/s00383-017-4073-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND/PURPOSE Adrenocortical tumors (ACTs) are rare in childhood. There are no recognized criteria to exactly distinguish between benign and malignant forms, or predict prognosis. The incidence of tumor varies across geographic regions or ethnicities, as well as malignant proportion. The aim of this study is to examine a single institution's experience with pediatric ACTs and to validate the prognostic value of the biologic/pathologic criteria of Wienecke. METHODS Records of 26 pediatric ACTs between 1994 and 2016 in our center were reviewed retrospectively. The data recorded of each patient included clinical characteristics, treatment, pathologic findings, disease stating, and outcome. Tumors were categorized according to the Wienecke criteria. RESULTS All patients underwent primary surgical excision, including negative margins in 20 cases. Stage distribution at diagnosis was: ST I 12, ST II 8, ST III 5, and ST IV 1. According to Wienecke scoring system, 13 cases were <3 criteria, 6 cases were =3 criteria, and 7 cases were >3 criteria. At median follow-up of 34.5 months, 18 patients survived without evidence of disease and 8 patients had lethal outcome. There was a strong association between high Wienecke score and both high stage and adverse outcome. CONCLUSIONS Wienecke criteria can be an appropriate points-scoring system to predict prognosis for adrenocortical tumors in children. Complete surgical resection with negative margins is optimal for survival.
Collapse
Affiliation(s)
- Wei Ru
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Min Yang
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Shan Xu
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China.
| | - Minju Li
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Daxing Tang
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| |
Collapse
|
60
|
Das S, Sengupta M, Islam N, Roy P, Datta C, Mishra PK, Banerjee S, Chaudhuri MK, Chatterjee U. Weineke criteria, Ki-67 index and p53 status to study pediatric adrenocortical tumors: Is there a correlation? J Pediatr Surg 2016; 51:1795-1800. [PMID: 27567308 DOI: 10.1016/j.jpedsurg.2016.07.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/21/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Adrenocortical tumors (ACTs) are rare in pediatric age group. Pediatric ACTs behave differently from their histologically similar adult counterparts and Weiss criteria often cannot accurately predict their clinical behavior. Wieneke et al. proposed a set of 9 macroscopic and microscopic criteria for diagnosis of malignancy in pediatric ACTs. The aim of the present study was to validate the Wieneke criteria in pediatric ACTs and to correlate Ki-67 labeling index and p53 expression with the Wieneke score. METHODS Our study comprised 17 cases of pediatric ACTs more than 11years, from January 2005 to December 2015. Relevant clinical features were obtained from records. Comprehensive analysis of gross and microscopic features was performed, according to the criteria proposed by Wieneke et al. Each tumor was categorized as benign, intermediate for malignancy or malignant. Ki-67 and p53 immunostaining was done in all cases. The patients were followed-up over a period of 6months to 60months. RESULTS Applying Wieneke criteria, there were 9 benign and 7 malignant cases, and 1 case was assigned as intermediate for malignancy. The most significant markers in favor of malignancy were capsular and venous invasion, followed by the presence of mitotic figures >15/20 HPF. p53 was over-expressed in 86% of the carcinomas. We found a significant correlation between Ki-67 index and Wieneke scoring system. All cases of adenoma achieved complete remission, while 3 patients with carcinoma died. CONCLUSION Our study validates the utility of Wieneke criteria in differentiating adrenocortical carcinomas from adenomas in pediatric age group. Moreover, Ki-67 index and p53 status can be used as supplementary tools in distinguishing adrenocortical carcinomas from adenomas.
Collapse
Affiliation(s)
- Soutrik Das
- Department of Pathology, IPGME&R, Kolkata, India.
| | | | | | | | | | | | - Sugato Banerjee
- Department of Pediatric Surgery, Park Clinic, Kolkata, India.
| | | | | |
Collapse
|
61
|
Kang E, Cho JH, Choi JH, Yoo HW. Etiology and therapeutic outcomes of children with gonadotropin-independent precocious puberty. Ann Pediatr Endocrinol Metab 2016; 21:136-142. [PMID: 27777905 PMCID: PMC5073159 DOI: 10.6065/apem.2016.21.3.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/05/2016] [Accepted: 04/12/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study was performed to investigate the etiology, clinical features, and outcomes of patients with gonadotropin-independent precocious puberty (GIPP). METHODS The study included 16 patients (14 female and 2 male patients) who manifested secondary sexual characteristics, elevated sex hormones, or adrenal androgens with prepubertal luteinizing hormone levels after gonadotropin releasing hormone stimulation diagnosed between May 1994 and December 2015. Patients with congenital adrenal hyperplasia were excluded. Clinical features, laboratory findings, treatment modalities, and outcomes were retrospectively reviewed. RESULTS The median age at diagnosis was 2.6 years (range, 0.7-7.9 years) and median follow-up duration was 4.6 years (range, 1 month-9.8 years). Patients with McCune-Albright syndrome (n=5) and functional ovarian cysts (n=4) presented with vaginal bleeding and elevated estradiol levels (23.3±17.5 pg/mL); adrenocortical tumors (n=4) with premature pubarche and elevated dehydroepiandrosterone sulfate levels (87.2-6,530 µg/dL); and human chorionic gonadotropin (hCG)-producing tumor (n=1) with premature pubarche and elevated β-human chorionic gonadotropin levels (47.4 mIU/mL). Two patients were idiopathic. Six patients transited to gonadotropin-dependent precocious puberty median 3.3 years (range, 0.3-5.1 years) after the onset of GIPP. Initial and follow-up height standard deviation scores (0.99±0.84 vs. 1.10±1.10, P=0.44) and bone age advancement (1.49±1.77 years vs. 2.02±1.95 years, P=0.06) were not significantly different. CONCLUSION The etiologies of GIPP are heterogeneous, and treatment and prognosis is quite different according to the etiology. Efficacy of treatment with aromatase inhibitors needs to be evaluated after long-term follow-up.
Collapse
Affiliation(s)
- Eungu Kang
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ja Hyang Cho
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Ho Choi
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Han-Wook Yoo
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
62
|
Xu X, Sergi C. Pediatric adrenal cortical carcinomas: Histopathological criteria and clinical trials. A systematic review. Contemp Clin Trials 2016; 50:37-44. [DOI: 10.1016/j.cct.2016.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/01/2016] [Accepted: 07/10/2016] [Indexed: 12/14/2022]
|
63
|
Madeleine MM, Johnson LG, Doody DR, Tipton ER, Carter JJ, Galloway DA. Natural Antibodies to Human Papillomavirus 16 and Recurrence of Vulvar High-Grade Intraepithelial Neoplasia (VIN3). J Low Genit Tract Dis 2016; 20:257-60. [PMID: 27224532 PMCID: PMC4920724 DOI: 10.1097/lgt.0000000000000227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Approximately 30% of women treated for squamous high-grade intraepithelial neoplasia (VIN3), often associated with human papillomavirus (HPV), have recurrent disease. In this study, we assess predictors of recurrence that may provide targets for early prevention or treatment. MATERIALS AND METHODS Women with VIN3 who participated in a previous population-based case-control study with blood and tumor samples completed a follow-up telephone interview an average of 5 years after initial diagnosis. The risk of recurrence was determined by proportional hazards modeling. RESULTS Women with VIN3 in the follow-up study (n = 65) were similar to women with VIN3 in the parent study (n = 215) with regard to age at primary diagnosis, level of current cigarette smoking (>60%), and lifetime number of partners. We found that 22 (33.8%) of 65 participants had a vulvar recurrence and that 73.4% recurred within 3 years of treatment. Recurrences occurred more often among women with common warts in the decade before diagnosis (hazard ratio [HR] = 2.5, 95% CI = 1.1-5.8) and among those with a previous anogenital cancer (HR = 2.7, 95% CI = 1.2-6.3). Interestingly, recurrence was less frequent among women who mounted a natural antibody response to HPV16 (HR = 0.4, 95% CI = 0.2-0.9). CONCLUSIONS These data provide strong preliminary evidence that VIN3 recurrence was less frequent among those with HPV16 antibodies. Vaccination with the currently licensed HPV vaccine as part of adjunctive therapy for VIN3 would increase antibody response and may decrease risk of recurrence. Randomized controlled trials are needed to determine whether HPV vaccination is effective against VIN3 recurrence.
Collapse
Affiliation(s)
- Margaret M. Madeleine
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Microbiology, University of Washington, Seattle, WA
| | - Lisa G. Johnson
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Microbiology, University of Washington, Seattle, WA
| | - David R. Doody
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Microbiology, University of Washington, Seattle, WA
| | - Elaine R. Tipton
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Microbiology, University of Washington, Seattle, WA
| | - Joseph J. Carter
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Microbiology, University of Washington, Seattle, WA
| | - Denise A. Galloway
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Microbiology, University of Washington, Seattle, WA
| |
Collapse
|
64
|
Pinto EM, Rodriguez-Galindo C, Choi JK, Pounds S, Liu Z, Neale G, Finkelstein D, Hicks JM, Pappo AS, Figueiredo BC, Ribeiro RC, Zambetti GP. Prognostic Significance of Major Histocompatibility Complex Class II Expression in Pediatric Adrenocortical Tumors: A St. Jude and Children's Oncology Group Study. Clin Cancer Res 2016; 22:6247-6255. [PMID: 27307598 DOI: 10.1158/1078-0432.ccr-15-2738] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/28/2016] [Accepted: 05/24/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Histologic markers that differentiate benign and malignant pediatric adrenocortical tumors are lacking. Previous studies have implicated an association of MHC class II expression with adrenocortical tumor prognosis. Here, we determined the expression of MHC class II as well as the cell of origin of these immunologic markers in pediatric adrenocortical tumor. The impact of MHC class II gene expression on outcome was determined in a cohort of uniformly treated children with adrenocortical carcinomas. EXPERIMENTAL DESIGN We analyzed the expression of MHC class II and a selected cluster of differentiation genes in 63 pediatric adrenocortical tumors by Affymetrix Human U133 Plus 2.0 or HT HG-U133+PM gene chip analyses. Cells expressing MHC class II were identified by morphologic and immunohistochemical assays. RESULTS MHC class II expression was significantly greater in adrenocortical adenomas than in carcinomas (P = 4.8 ×10-6) and was associated with a higher progression-free survival (PFS) estimate (P = 0.003). Specifically, HLA-DPA1 expression was most significantly associated with PFS after adjustment for tumor weight and stage. HLA-DPA1 was predominantly expressed by hematopoietic infiltrating cells and undetectable in tumor cells in 23 of 26 cases (88%). CONCLUSIONS MHC class II expression, which is produced by tumor-infiltrating immune cells, is an indicator of disease aggressiveness in pediatric adrenocortical tumor. Our results suggest that immune responses modulate adrenocortical tumorigenesis and may allow the refinement of risk stratification and treatment for this disease. Clin Cancer Res; 22(24); 6247-55. ©2016 AACR.
Collapse
Affiliation(s)
- Emilia Modolo Pinto
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - John Kim Choi
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stanley Pounds
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhifa Liu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Geoffrey Neale
- Hartwell Center, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - David Finkelstein
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - John M Hicks
- Department of Pathology, Texas Children's Hospital, Houston, Texas
| | - Alberto S Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Bonald C Figueiredo
- Instituto de Pesquisa Pelé Pequeno Príncipe and Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Raul C Ribeiro
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - Gerard P Zambetti
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee.
| |
Collapse
|
65
|
McDuffie LA, Aufforth RD. Adrenocortical carcinoma: modern management and evolving treatment strategies. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2016; 3:161-174. [PMID: 27213037 DOI: 10.2217/ije-2015-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare cancer with a poor prognosis. Unlike many other cancers, there has been little improvement in patient outcome over the past several decades. However, as scientific advancements are made and our understanding of the molecular genetics involved in ACC improve then progress may be achieved in this devastating disease. This review focuses on recent literature published in the field of ACC from 2010 to 2015 with an emphasis on improving diagnosis, staging and treatment for ACC.
Collapse
Affiliation(s)
- Lucas A McDuffie
- Thoracic & Gastrointestinal Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | | |
Collapse
|
66
|
Breidbart E, Cameo T, Garvin JH, Hibshoosh H, Oberfield SE. Pubertal outcome in a female with virilizing adrenocortical carcinoma. J Pediatr Endocrinol Metab 2016; 29:503-9. [PMID: 26812773 PMCID: PMC4836965 DOI: 10.1515/jpem-2015-0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 11/30/2015] [Indexed: 11/15/2022]
Abstract
Adrenocortical tumors are neoplasms that rarely occur in pediatric patients. Adrenocortical carcinoma (ACC) is even more uncommon, and is an aggressive malignancy with 5-year survival of 55% in a registry series. There is a lack of information on long-term endocrine outcome in survivors. We describe a 10-year follow-up in a patient who presented at 3 years 5 months with a 1-year history of axillary odor and 6 months' history of pubic hair development with an increased clitoral size. Androgen levels were increased and a pelvic sonogram revealed a suprarenal mass of the left kidney. The tumor was successfully removed. At 6 years 11 months, androgen levels increased again. Workup for tumor recurrence was negative and the findings likely represented early adrenarche. The patient had menarche at an appropriate time and attained a height appropriate for her family.
Collapse
Affiliation(s)
- Emily Breidbart
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, New York, NY, USA
| | - Tamara Cameo
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, New York, NY, USA
| | - James H. Garvin
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, New York, NY, USA
| | - Hanina Hibshoosh
- Division of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Sharon E. Oberfield
- Division of Pediatric Endocrinology, Diabetes and Metabolism, New York Presbyterian Hospital-Columbia University Medical Center, 622 West 168th Street PH 5E 522, New York, NY 10032, USA
| |
Collapse
|
67
|
Asher A, Fu JB, Bailey C, Hughes JK. Fatigue among patients with brain tumors. CNS Oncol 2016; 5:91-100. [PMID: 26987038 PMCID: PMC6047436 DOI: 10.2217/cns-2015-0008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/14/2016] [Indexed: 12/27/2022] Open
Abstract
Fatigue is a ubiquitous and an extremely distressing symptom among patients with brain tumors (BT), particularly those with high-grade gliomas. The pathophysiology of cancer-related fatigue (CRF) in the context of patients with BT is multifactorial and complex, involving biological, behavioral, medical and social factors. The etiology of CRF in the general oncology population is pointing to the role of inflammatory cytokines as a key factor in the genesis of CRF, but this research is currently limited in the setting of BT. CRF should be screened, assessed and managed according to clinical practice guidelines. Fatigue has recently emerged as a strong, independent prognostic factor for survival that provides incremental prognostic value to the traditional markers of prognosis in recurrent high-grade gliomas. Therefore, strategies to treat fatigue warrant investigation, not only to improve the QOL of a group of patients with often limited life expectancy, but also possibly to optimize survival.
Collapse
Affiliation(s)
- Arash Asher
- Cancer Survivorship & Rehabilitation, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Assistant Clinical Professor, Health Sciences, UCLA, 8700 Beverly Boulevard, AC 1109 Los Angeles, 90048, USA
| | - Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX 77030, USA
| | - Charlotte Bailey
- Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Jennifer K Hughes
- Department of Rehabilitation, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| |
Collapse
|
68
|
Golpanian S, Perez EA, Tashiro J, Lew JI, Sola JE, Hogan AR. Pediatric papillary thyroid carcinoma: outcomes and survival predictors in 2504 surgical patients. Pediatr Surg Int 2016; 32:201-8. [PMID: 26717936 DOI: 10.1007/s00383-015-3855-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate outcomes and predictors of survival of pediatric thyroid carcinoma, specifically papillary thyroid carcinoma. METHODS SEER was searched for surgical pediatric cases (≤20 years old) of papillary thyroid carcinoma diagnosed between 1973 and 2011. Demographics, clinical characteristics, and survival outcomes were analyzed using standard statistical methods. All papillary types, including follicular variant, were included. RESULTS A total of 2504 cases were identified. Overall incidence was 0.483/100,000 persons per year with a significant annual percent change (APC) in occurrence of 2.07 % from baseline (P < 0.05). Mean age at diagnosis was 16 years and highest incidence was found in white, female patients ages 15-19. Patients with tumor sizes <1 cm more likely received lobectomies/isthmusectomies versus subtotal/total thyroidectomies [OR = 3.03 (2.12, 4.32); P < 0.001]. Patients with tumors ≥1 cm and lymph node-positive statuses [OR = 99.0 (12.5, 783); P < 0.001] more likely underwent subtotal/total thyroidectomy compared to lobectomy/isthmusectomy. Tumors ≥1 cm were more likely lymph node-positive [OR = 39.4 (16.6, 93.7); p < 0.001]. Mortality did not differ between procedures. Mean survival was 38.6 years and higher in those with regional disease. Disease-specific 30-year survival ranged from 99 to 100 %, regardless of tumor size or procedure. Lymph node sampling did not affect survival. CONCLUSIONS The incidence of pediatric papillary thyroid cancer is increasing. Females have a higher incidence, but similar survival to males. Tumors ≥1 cm were likely to be lymph node-positive. Although tumors ≥1 cm were more likely to be resected by subtotal/total thyroidectomy, survival was high and did not differ based on procedure.
Collapse
Affiliation(s)
- Samuel Golpanian
- Division of Pediatric Surgery, DeWitt Daughtry Family, Department of Surgery, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Suite 450J, Miami, FL, 33136, USA
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt Daughtry Family, Department of Surgery, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Suite 450J, Miami, FL, 33136, USA
| | - Jun Tashiro
- Division of Pediatric Surgery, DeWitt Daughtry Family, Department of Surgery, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Suite 450J, Miami, FL, 33136, USA
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Family, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt Daughtry Family, Department of Surgery, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Suite 450J, Miami, FL, 33136, USA
| | - Anthony R Hogan
- Division of Pediatric Surgery, DeWitt Daughtry Family, Department of Surgery, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Suite 450J, Miami, FL, 33136, USA.
| |
Collapse
|
69
|
Gulack BC, Rialon KL, Englum BR, Kim J, Talbot LJ, Adibe OO, Rice HE, Tracy ET. Factors associated with survival in pediatric adrenocortical carcinoma: An analysis of the National Cancer Data Base (NCDB). J Pediatr Surg 2016; 51:172-7. [PMID: 26572849 PMCID: PMC5131646 DOI: 10.1016/j.jpedsurg.2015.10.039] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 10/09/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Adrenocortical carcinoma (ACC) is a rare tumor in children with important distinctions from the adult disease. We reviewed the National Cancer Data Base (NCDB) to determine factors associated with long-term survival. METHODS The NCDB was queried for patients less than 18 years of age who were diagnosed with ACC between 1998 and 2011. Kaplan-Meier analysis was utilized to determine factors significantly associated with overall survival. RESULTS A total of 111 patients were included (median age: 4 years, 69% female). ACC was more common in the youngest cohort, with 48% of cases occurring in children younger than the age of 3. Median tumor size was 9.5 cm (IQR: 6.5-13.0), and 87% of patients underwent some form of surgical resection. Among children with available data, 19 of 62 presented with metastases. Overall 1- and 3-year survival was 70% and 64%, respectively. Age, tumor size, extension of tumor into surrounding tissue, and metastatic disease were all found to be significantly associated with survival. Among patients who underwent a surgical procedure, margin status was also found to be significantly associated with survival. CONCLUSION Age, tumor size, extension of tumor, metastatic disease, and margin status are significantly associated with long-term survival in children with adrenocortical carcinoma.
Collapse
Affiliation(s)
| | | | | | - Jina Kim
- Department of Surgery, Duke University Medical Center, Durham, NC.
| | | | | | | | - Elisabeth T. Tracy
- Corresponding author at: Duke University Medical Center, DUMC Box #: 3815, Durham NC 27710. Tel.: +1 919 681 5077; fax: +1 919 681 8353
| |
Collapse
|
70
|
Marret JB, Raffoul L, Ribault V, Ravasse P, Rod J. Adrenocortical tumor with precocious puberty in a 2-month-old girl. Pediatr Int 2015; 57:1025-7. [PMID: 26508188 DOI: 10.1111/ped.12702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 03/14/2015] [Accepted: 03/26/2015] [Indexed: 11/30/2022]
Abstract
Adrenocortical tumor is a rare childhood tumor with a median age at onset of 3.2 years. Virilization is the most common sign. Laparotomy is the reference treatment and has a favorable course. The diagnosis of adrenal tumor can be difficult. The main parameters of malignant tumors are size and metastasis. Analysis of TP53 mutation can facilitate final diagnosis. We report a case of virilizing adrenal tumor that developed in a 2-month-old girl, and which was treated with laparoscopic adrenalectomy.
Collapse
Affiliation(s)
| | - Lara Raffoul
- Department of Pediatric Surgery, University of Necker Hospital, Paris, France
| | - Virginie Ribault
- Department of Pediatric Endocrinology, University of Caen Hospital, Caen, France.,University of Caen Hospital, Caen, France.,University of Caen Normandy, UFR Medicine, Caen, France
| | - Philippe Ravasse
- Department of Pediatric Surgery, University of Caen Hospital, Caen, France.,University of Caen Hospital, Caen, France.,University of Caen Normandy, UFR Medicine, Caen, France
| | - Julien Rod
- Department of Pediatric Surgery, University of Caen Hospital, Caen, France.,University of Caen Hospital, Caen, France.,University of Caen Normandy, UFR Medicine, Caen, France
| |
Collapse
|
71
|
Chatterjee G, DasGupta S, Mukherjee G, Sengupta M, Roy P, Arun I, Datta C, Mishra PK, Banerjee S, Chatterjee U. Usefulness of Wieneke criteria in assessing morphologic characteristics of adrenocortical tumors in children. Pediatr Surg Int 2015; 31:563-71. [PMID: 25895073 DOI: 10.1007/s00383-015-3708-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Adrenocortical tumors (ACT) occur rarely in pediatric age group. Pediatric ACTs behave differently from their histologically similar adult counterparts and standard adult criteria often cannot accurately predict their clinical behavior. The aim of the present study was to document the clinicopathologic spectrum of pediatric ACTs and to assess the utility of Wieneke scoring system in predicting clinical behavior of these tumors. METHODS This multi-institutional study comprised of 13 cases of pediatric ACTs from January 2005 to May 2014. Clinical features and gross pathologic characteristics were obtained from records. Comprehensive analyses of microscopic features were performed. Each tumor was assessed according to criteria proposed by Wieneke et al. and was assigned to benign, intermediate for malignancy or malignant group. The standard adult Weiss criteria were also applied for comparison. RESULTS There were total 6 cases of adrenocortical adenomas and 7 cases of adrenocortical carcinomas. Most of the children (76.9%) presented with endocrine dysfunction. Lower age of presentation was significantly associated with better prognosis. Applying Wieneke criteria, there were 6 benign and 6 malignant cases and one case was assigned to intermediate for malignancy group. The clinical behavior of all the cases was consistent with Wieneke criteria categorization. Applying Weiss criteria, 3 cases with benign clinical behavior were assigned to malignant group. CONCLUSION Our study validates the reliability of Wieneke scoring system in predicting malignancy in pediatric ACTs. It is simple and easy to use and therefore useful in day-to-day practice.
Collapse
|
72
|
Mihai R. Diagnosis, treatment and outcome of adrenocortical cancer. Br J Surg 2015; 102:291-306. [PMID: 25689291 DOI: 10.1002/bjs.9743] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/31/2014] [Accepted: 11/11/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adrenocortical cancer (ACC) is a rare disease with a dismal prognosis. The majority of patients are diagnosed with advanced disease and raise difficult management challenges. METHODS All references identified in PubMed, published between 2004 and 2014, using the keywords 'adrenocortical cancer' or 'adrenal surgery' or both, were uploaded into a database. The database was interrogated using keywords specific for each field studied. RESULTS In all, 2049 publications were identified. There is ongoing debate about the feasibility and oncological outcomes of laparoscopic adrenalectomy for small ACCs, and data derived from institutional case series have failed to provide an evidence level above expert opinion. The use of mitotane (1-(2-chlorophenyl)-1-(4-chlorophenyl)-2,2-dichloroethane) in combination with chemotherapy in the treatment of metastatic disease has been assessed in an international randomized trial (FIRM-ACT trial) involving patients with ACC. Based on this trial, mitotane plus etoposide, doxorubicin and cisplatin is now the established first-line cytotoxic therapy owing to a higher response rate and longer median progression-free survival than achieved with streptozocin-mitotane. For patients with tumours smaller than 5 cm and with no signs of lymph node or distant metastases, survival is favourable with a median exceeding 10 years. However, the overall 5-year survival rate for all patients with ACC is only 30 per cent. CONCLUSION Open and potentially laparoscopic adrenalectomy for selected patients is the main treatment for non-metastatic ACC, but the overall 5-year survival rate remains low.
Collapse
Affiliation(s)
- R Mihai
- Department of Endocrine Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| |
Collapse
|
73
|
Wanis KN, Kanthan R. Diagnostic and prognostic features in adrenocortical carcinoma: a single institution case series and review of the literature. World J Surg Oncol 2015; 13:117. [PMID: 25889798 PMCID: PMC4384320 DOI: 10.1186/s12957-015-0527-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 02/28/2015] [Indexed: 01/18/2023] Open
Abstract
Background Adrenocortical carcinoma is a rare cancer, with an incidence in the literature of 0.5 to 2 cases per million population per year. Adult adrenocortical carcinoma has a poor prognosis, underscoring the importance of identifying diagnostic and prognostic markers. Methods We searched our laboratory database for all cases in the past 15 years with a diagnosis of adrenocortical carcinoma. The original slides were then reviewed for their histopathological features. A representative paraffin block was subjected to further immunohistochemical staining for Ki-67, inhibin, steroidogenic factor-1 (SF-1), p53, and Β-catenin. These slides were scored by the study pathologist who was blinded to all clinicopathological data. In addition, a comprehensive review of the relevant English literature in the past 15 years was conducted. Results Eight cases were identified, including two adrenal sarcomatoid carcinomas. Seven of the eight cases had a disrupted reticulin network. Six of the eight tumors had >10% Ki-67 expression. Five of the eight tumors had >10% p53 expression. Positive inhibin immunohistochemical staining was seen in three of the eight tumors, and positive SF-1 staining was seen in five of the seven stained tumors. Abnormal Β-catenin intracellular accumulation was noted in four of the eight tumors. The two tumors in our series with sarcomatoid histology did not stain positively for SF-1 or inhibin. Conclusions Eight cases of adrenocortical carcinoma, including two with sarcomatoid features are presented. The two sarcomatoid adrenocortical carcinomas in our series did not stain for SF-1 which suggests a possible de novo pathway of tumorigenesis for this rare variant. The reticulin staining method was a useful tool for rapid differentiation of adrenocortical adenomas and carcinomas. Diffuse p53 staining showed a trend for positive correlation with increased Ki-67 expression. Inhibin staining was inconsistently expressed in our cases of adrenocortical carcinoma. In conclusion, as adrenocortical carcinoma is a rare disease, we recommend future multicenter studies with appropriate sample sizes to further evaluate the efficacy of these diagnostic and prognostic markers.
Collapse
Affiliation(s)
- Kerollos N Wanis
- College of Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Rani Kanthan
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Canada. .,Royal University Hospital, Room 2868G-Wing, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada.
| |
Collapse
|
74
|
Ip JCY, Pang TCY, Glover AR, Soon P, Zhao JT, Clarke S, Robinson BG, Gill AJ, Sidhu SB. Immunohistochemical validation of overexpressed genes identified by global expression microarrays in adrenocortical carcinoma reveals potential predictive and prognostic biomarkers. Oncologist 2015; 20:247-56. [PMID: 25657202 PMCID: PMC4350804 DOI: 10.1634/theoncologist.2014-0392] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 01/02/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis. The aim of this study was to identify novel protein signatures that would predict clinical outcomes in a large cohort of patients with ACC based on data from previous gene expression microarray studies. MATERIALS AND METHODS A tissue microarray was generated from the paraffin tissue blocks of 61 patients with clinical outcomes data. Selected protein biomarkers based on previous gene expression microarray profiling studies were selected, and immunohistochemistry staining was performed. Staining patterns were correlated with clinical outcomes, and a multivariate analysis was undertaken to identify potential biomarkers of prognosis. RESULTS Median overall survival was 45 months, with a 5-year overall survival rate of 44%. Median disease-free survival was 58 months, with a 5-year disease-free survival rate of 44%. The proliferation marker Ki-67 and DNA topoisomerase TOP2A were associated with significantly poorer overall and disease-free survival. The results also showed strong correlation between the transcriptional repressor EZH2 and TOP2A expression, suggesting a novel role for EZH2 as an additional marker of prognosis. In contrast, increased expression of the BARD1 protein, with its ubiquitin ligase function, was associated with significantly improved overall and disease-free survival, which has yet to be documented for ACC. CONCLUSION We present novel biomarkers that assist in determining prognosis for patients with ACC. Ki-67, TOP2A, and EZH2 were all significantly associated with poorer outcomes, whereas BARD1 was associated with improved overall survival. It is hoped that these biomarkers may help tailor additional therapy and be potential targets for directed therapy.
Collapse
Affiliation(s)
- Julian C Y Ip
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Tony C Y Pang
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony R Glover
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Patsy Soon
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jing Ting Zhao
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Clarke
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Bruce G Robinson
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony J Gill
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Stan B Sidhu
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
75
|
Adrenocortical carcinoma with extension to the inferior vena cava and right atrium: 20-month-old girl with TP53 mutation. Radiol Case Rep 2015; 10:1084. [PMID: 27398116 PMCID: PMC4921159 DOI: 10.2484/rcr.v10i2.1084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 20-month-old female presented with respiratory distress and a right adrenal mass extending into the inferior vena cava and right atrium. The mass was initially thought to be neuroblastoma. Pathology later revealed adrenocortical carcinoma. Inferior vena cava extension is far more common in adrenocortical carcinoma than neuroblastoma, and its presence should prompt clinical and laboratory evaluation for an adrenocortical tumor. The genetic findings in TP53 associated with this disease are discussed.
Collapse
|
76
|
Adrenocortical carcinoma in children: first population-based clinicopathological study with long-term follow-up. Oncol Rep 2014; 32:2836-44. [PMID: 25241764 DOI: 10.3892/or.2014.3506] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/20/2014] [Indexed: 11/05/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is rare in both adult and pediatric populations. Literature suggests significant differences between children and adults in presentation, histological properties and outcome. The aim of this first nationwide study on pediatric ACC was to describe the incidence, presentation, pathological characteristics, treatment and survival in The Netherlands. All ACC patients aged <20 years at diagnosis and registered in the population-based Netherlands Cancer Registry between 1993 and 2010 were included. Clinical data were extracted from medical records. Archival histological slides were collected via the Dutch Pathology Registry (PALGA). We compared our findings to all clinical studies on pediatric ACC that were found on PubMed. Based on the results, 12 patients were identified: 8 females and 4 males. The median age was 4.1 years (range 1.1-18.6). The population-based age-standardized incidence rate for patients <20 years was 0.18 per million person-years. Autonomous hormonal secretion was present in 10 patients. Seven patients were aged ≤4 years at diagnosis, 5 presented with localized disease and 2 with locally advanced disease. Five patients were aged ≥5 years, 3 presented with distant metastases and 1 with locally advanced disease. For all patients, histological examination displayed malignant characteristics. All patients aged ≤4 years at diagnosis survived; the median follow-up was 97 months (57-179 months). All patients aged ≥5 years died; the median survival was 6 months (0-38 months). Pediatric ACC is extremely rare in the Western world. The clinical outcome was remarkably better in patients aged ≤4 years. This is in accordance with less advanced stage of disease at presentation, yet contrasts with the presence of adverse histological characteristics. Clinical management in advanced disease is adapted from adult practice in the absence of evidence regarding pediatric ACC.
Collapse
|
77
|
Pediatric histiocytoses in the United States: incidence and outcomes. J Surg Res 2014; 190:221-9. [DOI: 10.1016/j.jss.2014.03.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/09/2014] [Accepted: 03/21/2014] [Indexed: 11/22/2022]
|
78
|
Abstract
Adrenocortical carcinoma is a rare endocrine tumor with a poor prognosis. These tumors can be diagnostically challenging, and diagnostic algorithms and criteria continue to be suggested. Myxoid and oncocytic variants are important to recognize to not confuse with other tumors. In addition, the diagnostic criteria are different for oncocytic adrenal carcinomas than conventional carcinomas. Adrenocortical carcinomas usually occur in adults, but can also occur in children. In children these tumors are diagnostically challenging as the histologic features of malignancy seen in an adult tumor may not be associated with aggressive disease in a child. Adrenocortical carcinomas occur with increased frequency in Beckwith-Wiedemann and Li-Fraumeni syndromes, but most occur sporadically. Gene expression profiling by transcriptome analysis can discriminate adrenocortical carcinomas from adenomas and divide carcinomas into prognostic groups. The increasing understanding of the pathogenesis of these tumors may provide increasing treatment targets for this aggressive tumor.
Collapse
|