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de la Fouchardière C, Haissaguerre M, Decaussin-Petrucci M, Renaudin K, Deschamps F, Mirallié E, Murez T, Pattou F, Rocher L, Savoie PH, Faron M, Taieb D, Tabarin A, Bertherat J, Gimenez-Roqueplo AP, Amar L, Baudin E, Libé R. [French recommendations for malignant pheochromocytomas and paragangliomas by the national ENDOCAN-COMETE network]. Bull Cancer 2023; 110:1063-1083. [PMID: 37573200 DOI: 10.1016/j.bulcan.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 08/14/2023]
Abstract
Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, developed respectively in the adrenal medulla and in extra-adrenal locations. Their malignancy is defined by the presence of distant metastases. Forty percent of them are inherited and can be part of different hereditary syndromes. Their management is ensured in France by the multidisciplinary expert centers of the ENDOCAN-COMETE national network "Cancers of the Adrenal gland", certified by the National Cancer Institute and discussed within multidisciplinary team meetings. The diagnostic and therapeutic work-up must be standardized, based on an expert analysis of clinical symptoms, hormonal biological secretions, genetics, morphological and specific metabolic imaging. In the context of a heterogeneous survival sometimes beyond seven to ten years, therapeutic intervention must be justified. This is multidisciplinary and relies on surgery, interventional radiology, external or internal radiotherapy and medical treatments such as sunitinib or dacarbazine and temodal chemotherapy. The personalized approach based on functional imaging fixation status and genetics is progressing despite the extreme rarity of this disease.
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Affiliation(s)
| | - Magalie Haissaguerre
- CHU de Bordeaux, hôpital Haut Lévêque, service d'endocrinologie, centre coordonnateur ENDOCAN-COMETE, Pessac, France
| | | | - Karine Renaudin
- CHU de Nantes, hôpital Hôtel-Dieu, anatomo-pathologie, Nantes, France
| | - Fréderic Deschamps
- Gustave-Roussy Cancer Campus, département de radiologie interventionnelle, Villejuif, France
| | - Eric Mirallié
- CHU de Nantes, hôpital Hôtel-Dieu, chirurgie cancérologique, digestive et endocrinienne, Institut des maladies de l'appareil digestif, Nantes, France
| | - Thibaut Murez
- CHU de Montpellier, département d'urologie et transplantation rénale, Montpellier, France
| | - François Pattou
- CHRU de Lille, département de chirurgie endocrinienne et métabolique, Lille, France
| | - Laurence Rocher
- Université Paris-Saclay, BIOMAPS, hôpital Antoine-Béclère, service de radiologie, Clamart, France
| | - Pierre-Henri Savoie
- Hôpital d'instruction des Armées Sainte-Anne, service d'urologie, Toulon, France
| | - Matthieu Faron
- Gustave-Roussy Cancer Campus, service de chirurgie viscérale oncologique, Villejuif, France
| | - David Taieb
- La Timone University Hospital, CERIMED, Aix-Marseille University, département de médecine nucléaire, Marseille, France
| | - Antoine Tabarin
- CHU de Bordeaux, hôpital Haut Lévêque, service d'endocrinologie, centre coordonnateur ENDOCAN-COMETE, Pessac, France
| | - Jérôme Bertherat
- Hôpital Cochin, CHU de Paris-Centre, service d'endocrinologie, centre coordonnateur ENDOCAN-COMETE, Paris, France
| | | | - Laurence Amar
- Hôpital européen Georges-Pompidou, service d'hypertension artérielle, Paris, France
| | - Eric Baudin
- Gustave-Roussy Cancer Campus, service de cancérologie endocrine, centre coordonnateur ENDOCAN-COMETE, Villejuif, France
| | - Rossella Libé
- Hôpital Cochin, CHU de Paris-Centre, service d'endocrinologie, centre coordonnateur ENDOCAN-COMETE, Paris, France.
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Zhong H, Wang Z, Liu Y, Ke H, Liu P, Lian X, Xu Z. Efficacy and Safety of Ultrasound-Guided Percutaneous Ablation for Adrenal Metastases: A Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36840701 DOI: 10.1002/jum.16198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To assess the efficacy and safety of ultrasound-guided percutaneous ablation (US-PA) for adrenal metastases (AMs) using a meta-analysis. METHODS A systematic search of PubMed, Cochrane, Web of Science, and Embase electronic databases was performed to identify studies on US-PA for AM. Seven studies published between January 2000 and August 2022 were analyzed, which resulted in a sample size of 140 patients. Both random effects and common effects meta-analysis models were used to analyze the following efficacy and safety outcomes: the first and secondary technical success rate, 1-year overall survival rates, 1-year local tumor control rate, incidence rate of intraoperative hypertensive crises, and major complications. The subgroup analysis was performed to explore the origin of heterogeneity. RESULTS Among 140 patients from 7 studies included in this meta-analysis: 51 (36.43%) underwent radiofrequency ablation (RFA), and 89 (63.57%) underwent microwave ablation (MWA). Pooled data analysis revealed that the first and secondary technical success rates were 85% (95% confidence interval [CI], 73-96) and 99% (95% CI, 96-100), the 1-year overall survival rate was 83% (95% CI, 71-93), the 1-year local tumor control rate was 83% (95% CI, 75-90), and the incidence rate of intraoperative hypertensive crises was 14% (95% CI, 8-20). The overall rate of major complications was 3.6%. In the subgroup analysis, lower heterogeneity was indicated to be associated with mean tumor size and ablation type. CONCLUSIONS This meta-analysis showed that US-PA can be both effective and safe for AM in terms of overall survival, technical success rate, and local control for AM.
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Affiliation(s)
- Huohu Zhong
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zecheng Wang
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yingchao Liu
- Department of Anesthesiology, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Helin Ke
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Piaopiao Liu
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xihua Lian
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Zhenhong Xu
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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Cantley RL. Approach to Fine Needle Aspiration of Adrenal Gland Lesions. Adv Anat Pathol 2022; 29:373-379. [PMID: 35878423 DOI: 10.1097/pap.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Adrenal gland lesions are present in 1% to 5% of patients and are most commonly identified incidentally on abdominal imaging. Fine needle aspiration (FNA) cytology plays an important role in the initial workup of adrenal gland nodules, especially in patients with a known history of malignancy. The most common reason for adrenal gland FNA is to differentiate benign adrenal lesions, such as adrenal cortical adenoma, from metastatic malignancy. However, there is a significant cytomorphologic overlap between primary and metastatic adrenal neoplasms. This review focuses on the current state of adrenal gland FNA cytology, with an emphasis on distinguishing adrenocortical adenoma from carcinoma and adrenal cortical neoplasms from metastatic malignancies. The role of immunohistochemistry in specifically diagnosing adrenal neoplasms is discussed. Proposed diagnostic classification systems for adrenal gland FNA cytology are also described.
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Affiliation(s)
- Richard L Cantley
- Department of Pathology and Clinical Laboratories, University of Michigan-Michigan Medicine, Ann Arbor, MI
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Trabzonlu L, Jager L, Tabibi S, Compton ML, Weiss VL, Kanber Y, Robila V, Antic T, Maleki Z, Morency E, Barkan GA. Adrenal gland cytology reporting: a multi-institutional proposal for a standardized reporting system. Cancer Cytopathol 2022; 130:423-432. [PMID: 35244974 PMCID: PMC10191772 DOI: 10.1002/cncy.22564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND With the development of new technologies and the changing patient profiles, cytopathology departments receive increasing numbers of adrenal gland cytology specimens. In this study, the authors analyzed archival adrenal gland cytology cases and attempted to implement a diagnostic reporting system. DESIGN Retrospective electronic medical record search was performed for adrenal gland cytology specimens in seven tertiary care centers. The cytology diagnoses were grouped in 7 categories: nondiagnostic, nonneoplastic, benign adrenal cortical elements (BACE), primary neoplasm of noncortical origin (NONC), atypia of undetermined significance (AUS), suspicious for malignancy (SM), and malignant (MAL). If available, histopathology results of concurrent and/or follow-up biopsies and/or resections were documented. RESULTS A total of 473 adrenal gland cytology cases were included. BACE cases comprised 21.8%, whereas MAL cases were 57.5% of all cases. For BACE and MAL categories, there were 100% and 98.9% correlation, respectively, in the cases with histopathology follow-up. Six of 10 NONC cases had histopathology diagnoses and there were 3 pheochromocytomas and 3 schwannomas. Twenty-one AUS cases had histology follow-up and 10 (47.6%) of them were malignant. Six cases of SM had histopathology follow-up, and all of them were malignant on the follow-up. CONCLUSIONS The authors propose a 7-tier diagnostic scheme for adrenal gland cytology. The risk of malignancy was 98.9% in MAL cases (87/88) in the cohort. The only case with discordance was reported as "adrenal cortical adenoma with marked atypia"' on resection. There was no difference between endoscopic ultrasound-guided and percutaneous methods. Further studies are needed to validate and make this approach universal.
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Affiliation(s)
- Levent Trabzonlu
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Lucy Jager
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Seena Tabibi
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Margaret L. Compton
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vivian L. Weiss
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yonca Kanber
- Department of Pathology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Valentina Robila
- Department of Pathology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Tatjana Antic
- Department of Pathology, The University of Chicago Medical Center, Chicago, Illinois
| | - Zahra Maleki
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Elizabeth Morency
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Güliz A. Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
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Kanber Y, Pusztaszeri M, Auger M. Immunocytochemistry for diagnostic cytopathology-A practical guide. Cytopathology 2021; 32:562-587. [PMID: 34033162 DOI: 10.1111/cyt.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
Cytological specimens, which are obtained by minimally invasive methods, are an excellent source of diagnostic material. Sometimes they are the only material available for diagnosis as well as for prognostic/predictive markers. When cytomorphology is not straightforward, ancillary tests may be required for a definitive diagnosis to guide clinical management. Immunocytochemistry (ICC) is the most common and practical ancillary tool used to reach a diagnosis when cytomorphology is equivocal, to differentiate entities with overlapping morphological features, and to determine the cell lineage and the site of origin of a metastatic neoplasm. Numerous immunomarkers are available, and some are expressed in multiple neoplasms. To rule out entities within a differential diagnosis, the use of more than one marker, sometimes panels, is necessary. ICC panels for diagnostic purposes should be customised based on the clinical context and cytomorphology, and the markers should be used judiciously to preserve material for additional tests for targeted therapies in the appropriate setting. This review offers a practical guide for the use of ICC for diagnostic cytopathology, covering the most commonly encountered non-hematolymphoid diagnostic scenarios in various body sites.
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Affiliation(s)
- Yonca Kanber
- Department of Pathology, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Marc Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Manon Auger
- Department of Pathology, McGill University Health Center, McGill University, Montreal, QC, Canada
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Point du Jour KS, Alwelaie Y, Coleman A, Tadros T, Aneja R, Reid MD. Adrenal gland fine needle aspiration: a multi-institutional analysis of 139 cases. J Am Soc Cytopathol 2020; 10:168-174. [PMID: 32988789 DOI: 10.1016/j.jasc.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Adrenal gland lesions span a range of entities from benign and malignant primary neoplasms to metastatic tumors. Fine-needle aspiration (FNA) provides a minimally invasive diagnostic tool to stage patients with known malignancy and procure material for molecular testing. This study characterizes the clinicopathologic associations of patients with adrenal gland FNA from 2 large hospitals. MATERIALS AND METHODS FNAs were identified by query of electronic medical record from 2002-2019. Clinical and pathological information was collated and correlated with corresponding surgical diagnosis when available. RESULTS Of 139 cases, the majority (n = 127, 91%) were adequate computed tomography-guided FNAs and included the following diagnoses: positive for malignancy (n = 77, 55%), negative for malignancy (n = 32, 23%), neoplastic cells present (n = 16, 12%), nondiagnostic (n = 12, 9%), atypical (n = 1, 1%), and suspicious for carcinoma (n = 1, 1%). The majority (94%, n = 72 of 77) of malignancies were metastatic tumors, most frequently carcinoma (n = 53 of 72, 74%), followed by melanoma (n = 11 of 72, 15%), lymphoma (n = 4 of 72, 6%), and sarcoma (n = 4 of 72, 6%). Metastatic carcinomas included lung (n = 21 of 72, 29%), genitourinary (n = 12 of 72, 17%), and hepatobiliary or gastrointestinal tract (n = 11 of 72, 15%) primaries. Primary adrenal neoplasms (n = 23) included adenomas (n = 11 of 23, 48%), pheochromocytomas (n = 4 of 23, 17%), and myelolipomas (n = 3 of 23, 13%). Thirty-two patients with metastases died of disease after median follow-up of 8 months. CONCLUSIONS High specimen adequacy (n = 127, 91%) and low indeterminate rates (n = 2, 2%) are achieved with adrenal FNA. Most aspirated lesions represent metastases from primary lung carcinomas, but other primary sites including those below the diaphragm are part of the diagnostic differential. Adrenal metastasis was associated with a poor prognosis, with median survival of 8 months.
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Affiliation(s)
| | - Yazeed Alwelaie
- Department of Pathology, Emory University Hospital, Atlanta, Georgia
| | - Arlixer Coleman
- Department of Pathology, Grady Memorial Hospital, Atlanta, Georgia
| | - Talaat Tadros
- Department of Pathology, Grady Memorial Hospital, Atlanta, Georgia
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, Georgia
| | - Michelle D Reid
- Department of Pathology, Emory University Hospital, Atlanta, Georgia.
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Rakheja G, Handa U, Kaur R, Aggarwal P, Palta A. Cytological diagnosis of bilateral primary adrenal lymphoma with cutaneous involvement. Diagn Cytopathol 2020; 48:479-482. [PMID: 32011792 DOI: 10.1002/dc.24390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/20/2019] [Accepted: 01/22/2020] [Indexed: 11/09/2022]
Abstract
Primary adrenal lymphoma (PAL) is an extremely rare condition. We describe here, a case of bilateral adrenal lymphoma in a 62-year-old man. He later developed subcutaneous masses on the hand and the leg. Fine-needle aspiration cytology from the adrenals and the soft tissue swellings led to a diagnosis of non-Hodgkin's lymphoma (NHL). Histopathological examination from the lesion on the leg, confirmed the diagnosis to be B-cell NHL. The case highlights the cytomorphological findings of this unusual case. Awareness of this entity is essential to differentiate it from other common causes of adrenal enlargement and formulate an appropriate treatment.
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Affiliation(s)
- Garima Rakheja
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Uma Handa
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Ravinder Kaur
- Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Phiza Aggarwal
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Anshu Palta
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
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