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Ziogas IA, Hills-Dunlap JL, Corkum KS, Cost NG, Gosain A, Roach JP. Current Management Strategies and Outcomes in Children With Adrenocortical Carcinoma. J Surg Res 2024; 301:110-117. [PMID: 38925097 DOI: 10.1016/j.jss.2024.04.086] [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: 02/29/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is a rare but aggressive pediatric endocrine tumor. However, there is no recent US national report on the management or outcomes of pediatric ACC. We aimed to examine the clinical characteristics, current management strategies, and outcomes of pediatric ACC. METHODS In this retrospective National Cancer Database study between 2004 and 2019, children (<18 y) with ACC were included. Overall survival was examined by means of Kaplan-Meier method, log-rank tests, and Cox regression modeling. RESULTS Seventy-eight children with ACC were included. The median age was 10 y, the median tumor size was 10.2 cm, and 35.9% had metastasis at diagnosis. Most patients underwent surgical treatment (84.6%), 56.4% received chemotherapy, and 7.7% received radiation. The 1-, 3-, and 5-y overall survival rates were 87.0%, 62.0%, and 60.1%, respectively. In unadjusted analysis, surgical treatment was associated with improved overall survival (log-rank test, P < 0.001). In multivariable Cox regression, metastasis at diagnosis was associated with inferior overall survival (hazard ratio: 2.72, 95% confidence interval: 1.15-6.40, P = 0.02), when adjusting for age, tumor size, receipt of surgical treatment, and chemotherapy. In patients with nonmetastatic ACC, increasing age was associated with inferior overall survival (hazard ratio: 1.12, 95% confidence interval: 1.00-1.24, P = 0.04), when adjusting for tumor size, receipt of surgical treatment, and chemotherapy. CONCLUSIONS Most children with ACC in the USA undergo surgical treatment with about half of these also receiving chemotherapy. Metastasis at diagnosis was independently associated with inferior overall survival; in patients with nonmetastatic ACC, increasing age was independently associated with inferior overall survival.
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Affiliation(s)
- Ioannis A Ziogas
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado; Surgical Oncology Program, Children's Hospital Colorado, Aurora, Colorado.
| | - Jonathan L Hills-Dunlap
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado; Surgical Oncology Program, Children's Hospital Colorado, Aurora, Colorado
| | - Kristine S Corkum
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado; Surgical Oncology Program, Children's Hospital Colorado, Aurora, Colorado
| | - Nicholas G Cost
- Surgical Oncology Program, Children's Hospital Colorado, Aurora, Colorado; Division of Urology, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Ankush Gosain
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado; Surgical Oncology Program, Children's Hospital Colorado, Aurora, Colorado
| | - Jonathan P Roach
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado; Surgical Oncology Program, Children's Hospital Colorado, Aurora, Colorado
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Jiang Z, Zhou B, Zhang C, Wang C. Prognostic factors of adrenocortical carcinoma in children and adolescents: a population-based study. Int Urol Nephrol 2024:10.1007/s11255-024-04063-z. [PMID: 38653853 DOI: 10.1007/s11255-024-04063-z] [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: 03/06/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Adrenocortical carcinoma (ACC) is an uncommon adrenal gland endocrine tumor that has a poor prognosis in children. We aimed to conduct a population-based cohort study to predict overall survival (OS) in pediatric patients with ACC. METHODS We used the Surveillance, Epidemiology, and End Results (SEER) database to conduct a retrospective cohort research on pediatric patients diagnosed with ACC between 1975 and 2018. We examined demographic characteristics, tumor stage and size, treatment options, and survival results. Kaplane-Meier estimations were used to generate survival curves based on several parameters. To compare survival curves, the log-rank test was applied.Cox proportional-hazards regression was used to determine the variables related with OS. In addition, we created a nomogram to predict overall survival in pediatric ACC patients. RESULTS A total of 143 pediatric ACC patients were identified. Females were the most impacted (60.8%). Overall 1 year, 3 year, and 5 year survival rates were 75.0%, 57.6%, and 53.7% for all patients, respectively. In comparison to older patients (5-19 years), younger patients (≤ 4 years) were shown to have more positive characteristics, including a higher likelihood of local disease (29.4% vs. 14%, P < 0.001), tumors less than 10 cm (23.1% vs. 14.7%, P < 0.001), and improved overall survival (5 year OS 89.6% vs. 27.7%, P < 0.001). Age at diagnosis, SEER stage, and surgery were significant independent predictors of OS in this model, according to the results of Cox proportional hazard regression. After that, we developed a nomogram for predicting OS in children with ACC. Patients older than 4 years old had a higher chance of dying. Furthermore, the higher the SEER stage, the higher the risk of death. Patients who do not have surgery have a worse survival rate than those who do. CONCLUSIONS Our study revealed that age at diagnosis, SEER stage, and surgery were found to be the most important predictors of the overall survival of pediatric ACC. These findings contribute to the existing body of knowledge and emphasize the importance of continued research to advance our understanding of pediatric ACC and improve patient care.
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Affiliation(s)
- Zhihua Jiang
- Department of Plastic Surgery, Hangzhou Children's Hospital, Hangzhou, 310005, Zhejiang, China
| | - Bi Zhou
- Department of Pediatrics, Suzhou Hospital of Anhui Medical University, Suzhou, Anhui, China
| | - Caiyun Zhang
- Department of Pediatric Intensive Care Unit, Hangzhou Children's Hospital, Hangzhou, China
| | - Chen Wang
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, 310005, Zhejiang, China.
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Balderrama-Brondani V, Griffin AM, Owen TJ, Merriman KW, Chahla BB, Varghese J, Jimenez C, Waguespack SG, Graham PH, Perrier ND, Fisher SB, Karam JA, Shah AY, Campbell M, Hassan MM, Habra MA. Incidence and Geographical Distribution of Adrenocortical Carcinoma: Retrospective Analysis of a State Cancer Registry. Endocr Pract 2024; 30:25-30. [PMID: 37858722 DOI: 10.1016/j.eprac.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Adrenocortical carcinoma (ACC) is a rare malignancy without established association with environmental risk factors. ACC incidence is stable based on large surgical databases while referral centers data reported increasing number of cases seen. We studied ACC incidence and distribution at a county level to find potential ACC "hot spots" that could be linked to environmental exposures. METHODS A retrospective analysis of Texas Cancer Registry that included ACC patients diagnosed between 2000 and 2018. County-level heatmaps were created and compared with breast, prostate, and lung cancer. RESULTS We identified 448 ACC cases during the study period. Cases were registered in 110 of the 254 counties (43.3%) in Texas, representing 92.74% of the total population. The median incidence was 23 new cases/y (range 14-33). The mean population-adjusted ACC incidence rate was 0.104 per 100 000 per year (standard deviation 0.005; 95% CI, 0.092-0.116). Seven counties (6.3%) accounted for 215 (48.0%) cases, with more than 10 cases each and median standardized incidence ratio (SIR) of 0.1 (range, 0.0-0.9). One hundred three counties (93.7%) accounted for the remaining 233 cases (52%), with fewer than 10 cases per county. The highest standardized incidence ratios were found in counties with a median population of fewer than 14 000 residents and with only one reported case. CONCLUSION Our analysis is the first report to create ACC heatmap and could not detect any geographic clustering of ACC in Texas. The incidence of ACC remained stable and consistent with data from other large databases.
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Affiliation(s)
- Vania Balderrama-Brondani
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Allison M Griffin
- Department of Financial Planning & Analysis, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Taylor J Owen
- Department of Financial Planning & Analysis, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly W Merriman
- Department of Tumor Registry, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brenda B Chahla
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeena Varghese
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul H Graham
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy D Perrier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarah B Fisher
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amishi Y Shah
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew Campbell
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Manal M Hassan
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Ghosh C, Hu J, Kebebew E. Advances in translational research of the rare cancer type adrenocortical carcinoma. Nat Rev Cancer 2023; 23:805-824. [PMID: 37857840 DOI: 10.1038/s41568-023-00623-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/21/2023]
Abstract
Adrenocortical carcinoma is a rare malignancy with an annual worldwide incidence of 1-2 cases per 1 million and a 5-year survival rate of <60%. Although adrenocortical carcinoma is rare, such rare cancers account for approximately one third of patients diagnosed with cancer annually. In the past decade, there have been considerable advances in understanding the molecular basis of adrenocortical carcinoma. The genetic events associated with adrenocortical carcinoma in adults are distinct from those of paediatric cases, which are often associated with germline or somatic TP53 mutations and have a better prognosis. In adult primary adrenocortical carcinoma, the main somatic genetic alterations occur in genes that encode proteins involved in the WNT-β-catenin pathway, cell cycle and p53 apoptosis pathway, chromatin remodelling and telomere maintenance pathway, cAMP-protein kinase A (PKA) pathway or DNA transcription and RNA translation pathways. Recently, integrated molecular studies of adrenocortical carcinomas, which have characterized somatic mutations and the methylome as well as gene and microRNA expression profiles, have led to a molecular classification of these tumours that can predict prognosis and have helped to identify new therapeutic targets. In this Review, we summarize these recent translational research advances in adrenocortical carcinoma, which it is hoped could lead to improved patient diagnosis, treatment and outcome.
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Affiliation(s)
| | - Jiangnan Hu
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Electron Kebebew
- Department of Surgery, Stanford University, Stanford, CA, USA.
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
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Zhang K, Zhang Y, Zhang Y, Chao M. A retrospective analysis of the clinical characteristics of 207 hospitalized children with adrenal masses. Front Pediatr 2023; 11:1215095. [PMID: 37520057 PMCID: PMC10374947 DOI: 10.3389/fped.2023.1215095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
Objective The detection rates of adrenal masses (AMs) have recently increased. The present study aimed to examine the clinical characteristics of these adrenal masses for guiding the clinical diagnosis and treatment among hospitalized children. Methods The clinical data of AM cases admitted to our hospital from January 2014 to March 2023 were collected and analyzed retrospectively. The data included composition, sex, age, initial presentation, size and site of mass, functional tumor, intervention or surgery, pathological or clinical diagnosis, and imaging data. Results A total of 207 hospitalized children were included. Among them, adrenal hematoma was the most common finding (53.6%), followed by adrenal neuroblastoma (36.2%). Most masses were larger-sized (51.2%) and non-functional (94.7%). We found that adrenal hematoma commonly occurred in a neonate or child with abdominal trauma. Most adrenal hematoma cases were found in male patients (63.1%), on the right side (71.2%), and with sizes <4 cm (73.9%). Adrenal neuroblastoma was commonly detected in male patients (56.0%), on the right side (66.7%), and with sizes ≥4 cm (85.3%). Moreover, the metastases were frequently explored at the time of diagnosis. In addition, there was no significant difference between ultrasound and computed tomography (CT) scans under suspicion of hematoma (P > 0.05). However, CT showed a priority over ultrasound in the diagnosis of neuroblastoma (P < 0.05). Conclusion Most masses were non-functional and benign. Of these, adrenal hematoma was the most common type of pediatric AM, followed by adrenal neuroblastoma. They were both commonly found in male patients and on the right side. Neuroblastoma revealed a larger tumor size. Compared to cases of adrenal hematoma, cases of adrenal neuroblastoma required CT scans for further assessment.
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Affiliation(s)
| | | | | | - Min Chao
- Correspondence: Yin Zhang Min Chao
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Picard C. « Quand les tumeurs pédiatriques et adultes se rejoignent » Cas no 3. Ann Pathol 2023:S0242-6498(23)00114-1. [PMID: 37268545 DOI: 10.1016/j.annpat.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/14/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Cécile Picard
- Institut de pathologie Est, hospices civils de Lyon, 69500 Bron-Lyon, France.
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Al-Ghotani B, Alabdallah E, Shaaban V, Nemer F, Alsneeh A, Sharif FAL, Dalati H, Mansour M. Adrenocortical carcinoma in a 10-month-old infant: A literature review and a rare case report. Ann Med Surg (Lond) 2023; 85:1197-1205. [PMID: 37113825 PMCID: PMC10129272 DOI: 10.1097/ms9.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Adrenocortical carcinoma (ACC) in children is a rare condition. The annual incidence of ACC is extremely low, with only 0.2-0.3 cases per million children. The clinical presentations of ACC are numerous, such as terminal hair appearance, pubertal progress, hypercortisolism, enlarged clitoris, acne, systemic arterial hypertension, weight gain, and voice change. Case presentation A 10-month-old female infant presented by her parents to the Department of Endocrinology with a mass on the right adrenal gland and Cushing's syndrome symptoms. Surgery was performed. The death occurred after two times resuscitation due to sudden cardiac arrest. Clinical discussion The adrenal gland consists of two distinct parts. Different types of tumors arise from each part of the adrenal gland. The most common tumor in adrenomedullary tumors was neuroblastoma which accounted for 60.4% of adrenal tumors. ACC in children is a rare condition. The etiology of ACTs is unclear. Conclusion This case emphasizes that early diagnosis has a considerable role in preventing major complications. Also to advise considering ACC as a differential diagnosis when similar symptoms are found in an infant.
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Affiliation(s)
- Basel Al-Ghotani
- Faculty of Medicine
- Stemosis for Scientific Research
- Corresponding author. Address: Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic. E-mail address: (B. Al-Ghotani)
| | | | | | - Farah Nemer
- Faculty of Medicine
- Department of Anesthesia, Resuscitation and Intensive Care Unit, Faculty of Medicine, Damascus University
| | | | - Fawaz AL Sharif
- Faculty of Medicine
- Department of Pediatric Surgery, Children’s University Hospital, Damascus
| | - Husam Dalati
- Faculty of Medicine
- Department of Pediatric Surgery, Children’s University Hospital, Damascus
| | - Marah Mansour
- Faculty of Medicine, Tartous University, Tartous, Syrian Arab Republic
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Kuhlen M, Kunstreich M, Wudy SA, Holterhus PM, Lessel L, Schneider DT, Brecht IB, Schewe DM, Seitz G, Roecken C, Vokuhl C, Johann PD, Frühwald MC, Vorwerk P, Redlich A. Outcome for Pediatric Adreno-Cortical Tumors Is Best Predicted by the COG Stage and Five-Item Microscopic Score-Report from the German MET Studies. Cancers (Basel) 2022; 15:cancers15010225. [PMID: 36612221 PMCID: PMC9818514 DOI: 10.3390/cancers15010225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Background: Adrenocortical tumors (ACTs) encompassing the adrenocortical adenoma (ACA), carcinoma (ACC), and tumors of undetermined malignant potential (ACx) are rare endocrine neoplasms with a poor prognosis. We report on pediatric ACT patients registered with the Malignant Endocrine Tumor studies and explore the EXPeRT recommendations for management. Patients: Data from the ACT patients (<18 years) were analyzed. For the risk prediction, the patients were retrospectively assigned to the COG stages and the five-item score. Results: By December 2021, 161 patients with ACT (ACA n = 51, ACx n = 19, and ACC n = 91) had been reported (the median age at the diagnosis was 4.3 years with a range of 0.1−17.8), with lymph node and distant metastases in 10.7% and 18.9% of the patients with ACC/ACx. The mean follow-up was 4.5 years (with a range of 0−16.7). The three-year overall (OS) and event-free survival (EFS) rates were 65.5% and 50.6%. In the univariate analyses, the OS was impaired for patients aged ≥ 4 years (p = 0.001) with the initial biopsy (p = 0.016), tumor spillage (p = 0.028), incomplete tumor resection (p < 0.001), unfavorable histology (p = 0.047), and COG stages III/IV (p = 0.002). Multivariate analysis revealed COG stages III/IV and an unfavorable five-item score as independent negative prognostic factors for the EFS and OS. Conclusions: Age defines the clinical presentation and prognosis in pediatric ACTs. The outcome is best predicted by the COG stage and five-item score.
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Affiliation(s)
- Michaela Kuhlen
- Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
- Correspondence: ; Tel.: +49-821-400-169307
| | - Marina Kunstreich
- Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
- Pediatric Hematology/Oncology, Department of Pediatrics, Otto von Guericke University Children’s Hospital, 39106 Magdeburg, Germany
| | - Stefan A. Wudy
- Pediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, 35435 Giessen, Germany
| | - Paul-Martin Holterhus
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Christian-Albrechts-University Kiel & University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Lienhard Lessel
- Pediatric Hematology/Oncology, Department of Pediatrics, Otto von Guericke University Children’s Hospital, 39106 Magdeburg, Germany
| | | | - Ines B. Brecht
- Pediatric Oncology and Hematology, University Children’s Hospital, 72076 Tuebingen, Germany
| | - Denis M. Schewe
- Pediatric Hematology/Oncology, Department of Pediatrics, Otto von Guericke University Children’s Hospital, 39106 Magdeburg, Germany
| | - Guido Seitz
- Department of Pediatric Surgery and Urology, University Hospital Giessen-Marburg, 35033 Marburg, Germany
| | - Christoph Roecken
- Department of Pathology, Christian-Albrechts-University & University Hospital Schleswig-Holstein (UKSH), 24105 Kiel, Germany
| | - Christian Vokuhl
- Section of Pediatric Pathology, Department of Pathology, University Hospital Bonn, 53121 Bonn, Germany
| | - Pascal D. Johann
- Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
| | - Michael C. Frühwald
- Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
| | - Peter Vorwerk
- Pediatric Hematology/Oncology, Department of Pediatrics, Otto von Guericke University Children’s Hospital, 39106 Magdeburg, Germany
| | - Antje Redlich
- Pediatric Hematology/Oncology, Department of Pediatrics, Otto von Guericke University Children’s Hospital, 39106 Magdeburg, Germany
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Deng Y, Li H, Fu J, Pu Y, Zhang Y, Chen S, Tong S, Liu H. A hypoxia risk score for prognosis prediction and tumor microenvironment in adrenocortical carcinoma. Front Genet 2022; 13:796681. [PMID: 36583015 PMCID: PMC9792869 DOI: 10.3389/fgene.2022.796681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Adrenocortical carcinoma (ACC) is a rare malignant endocrine tumor derived from the adrenal cortex. Because of its highly aggressive nature, the prognosis of patients with adrenocortical carcinoma is not impressive. Hypoxia exists in the vast majority of solid tumors and contributes to invasion, metastasis, and drug resistance. This study aimed to reveal the role of hypoxia in Adrenocortical carcinoma and develop a hypoxia risk score (HRS) for Adrenocortical carcinoma prognostic prediction. Methods: Hypoxia-related genes were obtained from the Molecular Signatures Database. The training cohorts of patients with adrenocortical carcinoma were downloaded from The Cancer Genome Atlas, while another three validation cohorts with comprehensive survival data were collected from the Gene Expression Omnibus. In addition, we constructed a hypoxia classifier using a random survival forest model. Moreover, we explored the relationship between the hypoxia risk score and immunophenotype in adrenocortical carcinoma to evaluate the efficacy of immune check inhibitors (ICI) therapy and prognosis of patients. Results: HRS and tumor stage were identified as independent prognostic factors. HRS was negatively correlated with immune cycle activity, immune cell infiltration, and the T cell inflammatory score. Therefore, we considered the low hypoxia risk score group as the inflammatory immunophenotype, whereas the high HRS group was a non-inflammatory immunophenotype. In addition, the HRS was negatively related to the expression of common immune checkpoint molecules such as PD-L1, CD200, CTLA-4, and TIGIT, suggesting that patients with a lower hypoxia risk score respond better to immunotherapy. Conclusion: We developed and validated a novel hypoxia risk score to predict the immunophenotype and response of patients with adrenocortical carcinoma to immune check inhibitors therapy. These findings not only provide fresh prognostic indicators for adrenocortical carcinoma but also offer several promising treatment targets for this disease.
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Affiliation(s)
- Yuanyuan Deng
- Department of Geriatric Endocrine, Xiangya Hospital, Central South University, Changsha, China
| | - Huihuang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jinglan Fu
- Department of Geriatric Endocrine, Xiangya Hospital, Central South University, Changsha, China
| | - Ying Pu
- Department of Geriatric Endocrine, Xiangya Hospital, Central South University, Changsha, China
| | - Ying Zhang
- Department of Geriatric Endocrine, Xiangya Hospital, Central South University, Changsha, China
| | - Shijing Chen
- Department of Geriatric Endocrine, Xiangya Hospital, Central South University, Changsha, China
| | - Shiyu Tong
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Huixia Liu, ; Shiyu Tong,
| | - Huixia Liu
- Department of Geriatric Endocrine, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Huixia Liu, ; Shiyu Tong,
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Kim SE, Lee NY, Cho WK, Yim J, Lee JW, Kim M, Chung JH, Jung MH, Suh BK, Ahn MB. Adrenocortical carcinoma and a sporadic MEN1 mutation in a 3-year-old girl: a case report. Ann Pediatr Endocrinol Metab 2022; 27:315-319. [PMID: 35038837 PMCID: PMC9816470 DOI: 10.6065/apem.2142100.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/22/2021] [Indexed: 01/13/2023] Open
Abstract
Childhood adrenocortical carcinoma (ACC) is a rare disease that is mostly linked to familial cancer syndrome. Although the prevalence of ACC is extremely low in children, it is clinically important to diagnose ACC early because age and tumor stage are closely related to prognosis. From this perspective, understanding the underlying genetics and possible symptoms of ACC is crucial in managing ACC with familial cancer syndromes. In this report, we present the case of a 3-year-old girl who initially presented with symptoms of precocious puberty and was later found to have ACC by imaging analysis. On genetic analysis, the patient was found to have a MEN1 gene mutation. MEN1 mutations are found in patients with multiple endocrine neoplasia type 1 (MEN1), usually precipitating multiple endocrine tumors, including pituitary adenoma, parathyroid hyperplasia, and adrenal tumors. Although MEN1 mutation is usually inherited in an autosomal dominant manner, neither of the patient's parents had the same mutation, making hers a case of sporadic MEN1 mutation with initial presentation of ACC. The clinical course and further investigations of this patient are discussed in detail in this report.
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Affiliation(s)
- Sung Eun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Na Yeong Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Kyoung Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jisook Yim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Wook Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myungshin Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hee Chung
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Ho Jung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Kyu Suh
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Bae Ahn
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea,Address for correspondence: Moon Bae Ahn Department of Pediatrics, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seochogu, Seoul 06591, Korea
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11
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Bachega FS, Suartz CV, Almeida MQ, Brondani VB, Charchar HLS, Lacombe AMF, Martins-Filho SN, Soares IC, Zerbini MCN, Dénes FT, Mendonca B, Lopes RI, Latronico AC, Fragoso MCBV. Retrospective Analysis of Prognostic Factors in Pediatric Patients with Adrenocortical Tumor from Unique Tertiary Center with Long-Term Follow-Up. J Clin Med 2022; 11:jcm11226641. [PMID: 36431124 PMCID: PMC9692695 DOI: 10.3390/jcm11226641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Pediatric adrenocortical tumors (PACTs) represent rare causes of malignancies. However, the south/southeast regions of Brazil are known to have a high incidence of PACTs because of the founder effect associated with a germline pathogenic variant of tumor suppressor gene TP53. We aimed to retrospectively analyze the types of variables among hormone production, radiological imaging, tumor staging, histological and genetic features that were associated with the occurrence of malignancy in 95 patients (71% females) with PACTs from a unique center. The worst prognosis was associated with those aged > 3 years (p < 0.05), high serum levels of 11-desoxicortisol (p < 0.001), tumor weight ≥ 200 g (p < 0.001), tumor size ≥ 5 cm (p < 0.05), Weiss score ≥ 5 (p < 0.05), Wieneke index ≥ 3 (p < 0.001) and Ki67 ≥ 15% (p < 0.05). Furthermore, patients with MacFarlane stage IV had an overall survival rate almost two times shorter than patients with other stages (p < 0.001). Additionally, the subtractions of BUB1B-PINK1 (<6.95) expression (p < 0.05) and IGF-IR overexpression (p = 0.0001) were associated with malignant behavior. These results helped identify patients who are likely to have an aggressive course; further multicenter prospective studies are required to confirm our results. In conclusion, PACTs with these patterns of prognostic factors could be treated using an adjuvant approach that may improve the overall survival in such patients.
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Affiliation(s)
- Fernanda S. Bachega
- Unidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM/42, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05466-040, SP, Brazil
| | - Caio V. Suartz
- Divisão de Urologia, Departamento de Cirurgia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 1964-2007, SP, Brazil
| | - Madson Q. Almeida
- Unidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM/42, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05466-040, SP, Brazil
| | - Vania B. Brondani
- Unidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM/42, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05466-040, SP, Brazil
| | - Helaine L. S. Charchar
- Unidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM/42, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05466-040, SP, Brazil
| | - Amanda M. F. Lacombe
- Unidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM/42, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05466-040, SP, Brazil
| | - Sebastião N. Martins-Filho
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Iberê C. Soares
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Maria Claudia N. Zerbini
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Francisco T. Dénes
- Divisão de Urologia, Departamento de Cirurgia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 1964-2007, SP, Brazil
| | - Berenice Mendonca
- Unidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM/42, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05466-040, SP, Brazil
| | - Roberto I. Lopes
- Divisão de Urologia, Departamento de Cirurgia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 1964-2007, SP, Brazil
| | - Ana Claudia Latronico
- Unidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM/42, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05466-040, SP, Brazil
| | - Maria Candida B. V. Fragoso
- Unidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM/42, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05466-040, SP, Brazil
- Correspondence:
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12
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Paschoalin VP, Tucci Júnior S, G. Estevanato A, B. Tiraboschi R, Antonini SR, Muglia VF, Chahud F, Mermejo LM, de Bessa Júnior J, Fernandes Molina CA. Histopathological Criteria for Paediatric Adrenocortical Carcinoma. Horm Res Paediatr 2022; 95:347-353. [PMID: 35508143 PMCID: PMC9677829 DOI: 10.1159/000524892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/19/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is diagnosed in paediatric patients at 5 months after symptom onset on average, and 38% die during the first 2.5 years of follow-up. This study aimed to compare the accuracy of Weiss, Van Slooten, and Wieneke histopathological ACC classifications for predicting follow-up prognosis in a paediatric population. METHODS Data were retrieved from medical records of 57 patients aged <18 years who underwent surgical treatment for ACC with surgical follow-up over 6 months or death due to ACC. They were classified into either good (without recurrence/death due to ACC) or poor (with recurrence/death due to ACC) prognosis group. Two expert pathologists classified the ACC surgical specimens according to the Weiss, Van Slooten, and Wieneke criteria. RESULTS The median follow-up duration was 126 (18-225) months in 38 males (66.7%) and 19 females (33.3%) (median age: 3 [1-6.5] years). The good prognosis group was younger than the poor prognosis group (median age: 3 [1.5-6.2] years vs. 5 [2-10] years). Seventeen (29.8%) patients in the poor prognosis group died due to ACC within the first 50 months of surgical follow-up; the earliest death occurred in the fourth follow-up month, and the majority of deaths occurred within 24 months of follow-up. The accuracies of Weiss, Van Slooten, and Wieneke classification systems were 40%, 47%, and 77%, respectively. DISCUSSION/CONCLUSION The Wieneke classification showed the best accuracy but was not sufficiently precise to establish reliable prognosis for ACC in the paediatric population. The Wieneke classification had approximately 95% sensitivity and negative predictive value.
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Affiliation(s)
- Victor P. Paschoalin
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Silvio Tucci Júnior
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Andrey G. Estevanato
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Sonir R. Antonini
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Valdair F. Muglia
- Department of Medical Images, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Fernando Chahud
- Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Livia M. Mermejo
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - José de Bessa Júnior
- Department of Surgery, Feira de Santana State University, Feira de Santana, Brazil
| | - Carlos A. Fernandes Molina
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil,*Carlos A. Fernandes Molina,
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13
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Kuhlen M, Mier P, Kunstreich M, Lessel L, Schneider D, Brecht I, Schewe DM, Frühwald MC, Vorwerk P, Redlich A. Key factors for effective mitotane therapy in children with adrenocortical carcinoma. Endocr Relat Cancer 2022; 29:545-555. [PMID: 35900840 DOI: 10.1530/erc-22-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 11/08/2022]
Abstract
Adjuvant treatment with mitotane and chemotherapy is recommended for paediatric advanced and metastatic adrenocortical carcinoma (ACC). Yet, questions on the indication, dosage, and length of therapy are unanswered. Data from the German Paediatric Oncology Haematology-Malignant Endocrine Tumour studies were analysed retrospectively for patients receiving mitotane during first- and/or second-line therapy. Forty-three patients were identified (median age: 7.5 years (range: 0.2-17.8); 29 female) with median follow-up of 2.2 years (range: 0.04-12.71). Three-year overall (OS) and progression-free survival (PFS) were 44.9% and 28.5%, respectively. Eleven of 43 patients received mitotane as neoadjuvant treatment, and 4/11 tumours reached partial remission (PR). Twenty-seven of 43 patients received mitotane combined with chemotherapy in an adjuvant setting resulting in PR of measurable target lesions in 5/13 patients. Metastatic disease (hazard ratio (HR): 3.2; 95% CI: 1.2-18.6; P = 0.018), duration of mitotane treatment <9 months (HR: 5.6; 95% CI: 1.9-16.9; P = 0.002), and not achieving drug target range (TR) (HR: 28.5; 95% CI: 5.4-150.3; P < 0.001) significantly impacted as negative prognostic factors upon PFS and OS (metastatic disease: HR: 4.9; 95% CI: 1.6-15.5; P = 0.006; duration of mitotane treatment: HR: 7.0: 95% CI 1.9-26.0; P = 0.004; TR not reached: HR: 13.5; 95% CI 3.6-50.3; P < 0.001). Cox regression determined the risk of event decreasing by 10.4% for each month of mitotane treatment (P = 0.015). Re-treatment with mitotane after first-line treatment proved ineffective. The duration of mitotane treatment and reaching mitotane TR significantly impacted survival. Improving the efficacy of mitotane, including appropriate indications, needs to be evaluated in prospective randomized trials.
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Affiliation(s)
- Michaela Kuhlen
- Paediatric and Adolescent Medicine, Faculty of Medicine, University Medical Centre Augsburg, Augsburg, Germany
| | - Pascal Mier
- Department of Paediatric Haematology and Oncology, University Children's Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Marina Kunstreich
- Department of Paediatric Haematology and Oncology, University Children's Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Lienhard Lessel
- Department of Paediatric Haematology and Oncology, University Children's Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Dominik Schneider
- Clinic of Paediatrics, Klinikum Dortmund, University Witten/Herdecke, Dortmund, Germany
| | - Ines Brecht
- Paediatric Haematology/Oncology, Department of Paediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Denis M Schewe
- Department of Paediatric Haematology and Oncology, University Children's Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Michael C Frühwald
- Paediatric and Adolescent Medicine, Faculty of Medicine, University Medical Centre Augsburg, Augsburg, Germany
| | - Peter Vorwerk
- Department of Paediatric Haematology and Oncology, University Children's Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Antje Redlich
- Department of Paediatric Haematology and Oncology, University Children's Hospital, Otto-von-Guericke-University, Magdeburg, Germany
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14
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Osman AA, Omar Abdi A, Mohamud Abdullahi I, Tahtabasi M, Kaya V. Exceptional Clinical Response to Surgery in Somalian Child Affected by Hyper Secretive Adrenal Cortical Carcinoma. Int Med Case Rep J 2022; 15:343-348. [PMID: 35813968 PMCID: PMC9266659 DOI: 10.2147/imcrj.s370022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
Adrenocortical cancers in childhood are very rare tumors. They are categorized as functional (hormone-secreting) or silent and as either benign or malignant. They have a bimodal distribution. Although in most adults they are non-functional, in the pediatric age group they may present as hormonal active or as an active tumor presenting with either virilizing forms or Cushing’s syndrome or both sometimes. In children, due to the rapid development of symptoms, they come to attention early. However, if not diagnosed and treated early, they can develop into serious medical conditions. We present here a 6-year-old girl complaining of voice changes (deepening), extremely overweight, excessive hair growth over her body, and clitoromegaly for one year. Abdominal ultrasound and computed tomography revealed a well-defined adrenal mass with a slightly heterogeneous appearance and heterogeneous-contrast enhancement containing some necrotic areas. The patient was discharged one week after unilateral right adrenalectomy in good condition, and oral medications were given along with high-dose corticosteroid medications, which were reduced gradually. All the symptoms disappeared 6 months after the operation.
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Affiliation(s)
- Ahmed Adam Osman
- Department of Radiology, University of Health Sciences-Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
- Correspondence: Ahmed Adam Osman, Department of Radiology, University of Health Sciences- Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia, Tel +252615570262, Email
| | - Ahmed Omar Abdi
- Department of General Surgery, Shaafi Hospital, Mogadishu, Somalia
| | - Ismail Mohamud Abdullahi
- Department of Pathology, University of Health Sciences-Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
| | - Mehmet Tahtabasi
- Department of Radiology, University of Health Sciences-Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Veysel Kaya
- Department of Radiology, Harran University-Faculty of Medicine, Sanliurfa, Turkey
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15
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Lin X, Gu Y, Su Y, Dong Y, Major P, Kapoor A, Tang D. Prediction of Adrenocortical Carcinoma Relapse and Prognosis with a Set of Novel Multigene Panels. Cancers (Basel) 2022; 14:cancers14112805. [PMID: 35681785 PMCID: PMC9179637 DOI: 10.3390/cancers14112805] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/29/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023] Open
Abstract
Effective assessment of adrenocortical carcinoma (ACC) prognosis is critical in patient management. We report four novel and robust prognostic multigene panels. Sig27var25, SigIQvar8, SigCmbnvar5, and SigCmbn_B predict ACC relapse at area under the curve (AUC) of 0.89, 0.79, 0.78, and 0.80, respectively, and fatality at AUC of 0.91, 0.88, 0.85, and 0.87, respectively. Among their 33 component genes, 31 are novel. They could be differentially expressed in ACCs from normal tissues, tumors with different severity (stages and lymph node metastasis), ACCs with TP53 mutations, and tumors with differentially expressed immune checkpoints (CTLA4, PD1, TGFBR1, and others). All panels correlate with reductions of ACC-associated CD8+ and/or NK cells. Furthermore, we provide the first evidence for the association of mesenchymal stem cells (MSCs) with ACC relapse (p = 2 × 10−6) and prognosis (p = 2 × 10−8). Sig27var25, SigIQvar8, SigCmbnvar5, and SigCmbn_B correlate with MSC (spearman r ≥ 0.53, p ≤ 1.38 × 10−5). Sig27var25 and SigIQvar8 were derived from a prostate cancer (PC) and clear cell renal cell carcinoma (ccRCC) multigene signature, respectively; SigCmbnvar5 and SigCmbn_B are combinations of both panels, revealing close relationships of ACC with PC and ccRCC. The origin of these four panels from PC and ccRCC favors their prognostic potential towards ACC.
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Affiliation(s)
- Xiaozeng Lin
- Urological Cancer Center for Research and Innovation (UCCRI), St Joseph’s Hospital, Hamilton, ON L8N 4A6, Canada; (X.L.); (Y.G.); (Y.S.); (Y.D.)
- The Research Institute of St Joe’s Hamilton, St Joseph’s Hospital, Hamilton, ON L8N 4A6, Canada
- Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Yan Gu
- Urological Cancer Center for Research and Innovation (UCCRI), St Joseph’s Hospital, Hamilton, ON L8N 4A6, Canada; (X.L.); (Y.G.); (Y.S.); (Y.D.)
- The Research Institute of St Joe’s Hamilton, St Joseph’s Hospital, Hamilton, ON L8N 4A6, Canada
- Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Yingying Su
- Urological Cancer Center for Research and Innovation (UCCRI), St Joseph’s Hospital, Hamilton, ON L8N 4A6, Canada; (X.L.); (Y.G.); (Y.S.); (Y.D.)
- The Research Institute of St Joe’s Hamilton, St Joseph’s Hospital, Hamilton, ON L8N 4A6, Canada
- Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Ying Dong
- Urological Cancer Center for Research and Innovation (UCCRI), St Joseph’s Hospital, Hamilton, ON L8N 4A6, Canada; (X.L.); (Y.G.); (Y.S.); (Y.D.)
- The Research Institute of St Joe’s Hamilton, St Joseph’s Hospital, Hamilton, ON L8N 4A6, Canada
- Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Pierre Major
- Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada;
| | - Anil Kapoor
- Urological Cancer Center for Research and Innovation (UCCRI), St Joseph’s Hospital, Hamilton, ON L8N 4A6, Canada; (X.L.); (Y.G.); (Y.S.); (Y.D.)
- The Research Institute of St Joe’s Hamilton, St Joseph’s Hospital, Hamilton, ON L8N 4A6, Canada
- Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada
- Correspondence: (A.K.); (D.T.); Tel.: +1-905-522-1155 (ext. 35218) (A.K.); +1-905-522-1155 (ext. 35168) (D.T.)
| | - Damu Tang
- Urological Cancer Center for Research and Innovation (UCCRI), St Joseph’s Hospital, Hamilton, ON L8N 4A6, Canada; (X.L.); (Y.G.); (Y.S.); (Y.D.)
- The Research Institute of St Joe’s Hamilton, St Joseph’s Hospital, Hamilton, ON L8N 4A6, Canada
- Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada
- Correspondence: (A.K.); (D.T.); Tel.: +1-905-522-1155 (ext. 35218) (A.K.); +1-905-522-1155 (ext. 35168) (D.T.)
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Adrenocortical Carcinoma: a Therapeutic Challenge — 44 Cases from a Single Tertiary Care Center in India. Indian J Surg Oncol 2022; 13:251-259. [DOI: 10.1007/s13193-021-01440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 09/01/2021] [Indexed: 10/20/2022] Open
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Radiotherapy for Pediatric Adrenocortical Carcinoma – Review of the Literature. Clin Transl Radiat Oncol 2022; 35:56-63. [PMID: 35601796 PMCID: PMC9121070 DOI: 10.1016/j.ctro.2022.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 12/18/2022] Open
Abstract
Radiotherapy (RT) is mostly performed for curative intent, only few cases in palliative setting are reported. The site of RT was predominantly tumor bed, abdominal cavity, and/or metastases. Adjuvant RT has to be discussed—even in the context of TPSs—especially for patients with high risk factors. Evidence regarding RT in in pediatric adrenocortical carcinoma is too limited to give any general recommendation. However, we suggest to consider adjuvant radiotherapy in individual patients with high risk of recurrence. A systematic international study with a common data platform is needed to establish evidence. on the role of RT in the treatment of children with adrenocortical carcinoma and to improve the outcome in this rare disease.
Background and purpose Pediatric adrenocortical carcinoma (pACC) is a rare disease with poor prognosis. Publications on radiotherapy (RT) are scarce. This review summarizes the current data on RT for pACC and possibly provides first evidence to justify its use in this setting. Materials and methods We searched the PubMed and Embase database for manuscripts regarding RT for pACC. Results We included 17 manuscripts reporting on 76 patients treated with RT, after screening 2961 references and 269 full articles. In addition, we added data of 4 unreported pACC patients treated by co-authors. All reports based on retrospective data. Median age at first diagnosis was 11.1 years (70% female); 78% of patients presented with hormonal activity. RT was mostly performed for curative intent (78%). 88% of RT were administered during primary therapy. The site of RT was predominantly the local tumor bed (76%). Doses of RT ranged from 15 to 62 Gy (median 50 Gy). Information on target volumes or fractionation were lacking. Median follow-up was 6,9 years and 64% of the patients died of disease, with 33% alive without disease. In 16 of 48 patients with available follow-up data after adjuvant RT (33%) no recurrence was reported and in 3 of 9 patients palliative RT seemed to induce some benefit for the patient. Conclusions Our first systematic review on RT for pACC provides too few data for any general recommendation, but adjuvant RT in patients with high risk might be considered. International collaborative studies are urgently needed to establish better evidence on the role of RT in this rare malignancy.
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Akinkuotu AC, Peace A, Maduekwe UN, Hayes AA. Surgical outcomes and survival of adrenocortical carcinoma between children and adults. Am J Surg 2022; 224:1090-1094. [PMID: 35688671 DOI: 10.1016/j.amjsurg.2022.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/12/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is associated with poor outcomes. We compared surgical outcomes between children and adult; and identified factors independently associated with survival. METHODS Using the National Cancer Database, children and adults with ACC who underwent surgery between 2004 and 2016 were identified. We compared outcomes and survival between groups. Cox regression analysis was performed to identify predictors of survival. RESULTS Of 2553 patients, 2.8% were children. A higher proportion of children were Hispanic (19.1%vs.6.6%) and covered by government insurance (45.1%vs.35.8%) than adults. More pediatric patients received lymphadenectomy and chemotherapy than adults. Pediatric patients had better survival at 1 -(91.4%; 95%CI: 81.2%-96.0% vs.79.6%; 95%CI: 77.9%-81.1%) and 5-years (60.6%; 95%CI:47.5%-71.3% vs.44.9%; 95%CI 42.7%- 47.0) (p = 0.0016). Age≥18 (HR: 2.21(1.50-3.27)), metastatic disease at diagnosis (HR: 3.51(3.04-4.04)), and receipt of lymphadenectomy (HR: 1.30(1.14-1.48)) were independently associated with worse survival. CONCLUSIONS Children with ACC had better survival than adults. Factors independently associated with worse survival included older age, metastatic disease, and receipt of lymph node surgery.
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Affiliation(s)
- Adesola C Akinkuotu
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | - Alyssa Peace
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Ugwuji N Maduekwe
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Andrea A Hayes
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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Steenaard RV, Rutjens M, Ettaieb MHT, van Noesel MM, Haak HR. EDP-mitotane in children: reassuring evidence of reversible side-effects and neurotoxicity. Discov Oncol 2022; 13:25. [PMID: 35435506 PMCID: PMC9016089 DOI: 10.1007/s12672-022-00486-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/16/2022] [Indexed: 12/14/2022] Open
Abstract
Adrenocortical carcinoma affects one in 5 million children each year. Since prognosis for children older than 4 years is limited, clinicians often choose aggressive treatment with etoposide, doxorubicin, cisplatin (EDP) and mitotane after resection. However, little is known about the impact of EDP-mitotane in children. We provide an overview of case-reports and case series listing side-effects and neurotoxicity of EDP-mitotane in children. Fourteen studies were identified describing a range of gastro-intestinal, endocrine, developmental and neuropsychological side-effects. Neurotoxicity included motor- and speech delay, decreased concentration and lower school performance. These side-effects appear to be reversible after mitotane discontinuation. We have added our own experience with a 10 year old girl with advanced adrenocortical carcinoma treated with EDP and 2 years of mitotane after irradical resection. She developed an impactful, but reversible, decrease in cognitive development measured by a standardized neuropsychological assessment before, during and after mitotane therapy. This decrease was mostly measurable in terms of decreased processing speed and concentration and a significant drop in school performance. Combined with fatigue and insecurity, this caused problems in short-term memory and the need to change her school type. In conclusion, EDP-mitotane is associated with several side-effects including neurotoxicity in pediatric cases, all reversible after mitotane discontinuation.
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Affiliation(s)
- Rebecca V Steenaard
- Department of Internal Medicine, Máxima MC, Ds. Th. Fliedernerstraat 1, Eindhoven/Veldhoven, 5631 BM , The Netherlands.
- CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht University, Maastricht, The Netherlands.
| | - Marieke Rutjens
- Department of Internal Medicine, Máxima MC, Ds. Th. Fliedernerstraat 1, Eindhoven/Veldhoven, 5631 BM , The Netherlands
| | | | - Max M van Noesel
- Princes Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Division of Cancer and Imaging, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Harm R Haak
- Department of Internal Medicine, Máxima MC, Ds. Th. Fliedernerstraat 1, Eindhoven/Veldhoven, 5631 BM , The Netherlands
- CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Tabarin A, Assié G, Barat P, Bonnet F, Bonneville JF, Borson-Chazot F, Bouligand J, Boulin A, Brue T, Caron P, Castinetti F, Chabre O, Chanson P, Corcuff JB, Cortet C, Coutant R, Dohan A, Drui D, Espiard S, Gaye D, Grunenwald S, Guignat L, Hindie E, Illouz F, Kamenicky P, Lefebvre H, Linglart A, Martinerie L, North MO, Raffin-Samson ML, Raingeard I, Raverot G, Raverot V, Reznik Y, Taieb D, Vezzosi D, Young J, Bertherat J. Consensus statement by the French Society of Endocrinology (SFE) and French Society of Pediatric Endocrinology & Diabetology (SFEDP) on diagnosis of Cushing's syndrome. ANNALES D'ENDOCRINOLOGIE 2022; 83:119-141. [PMID: 35192845 DOI: 10.1016/j.ando.2022.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cushing's syndrome is defined by prolonged exposure to glucocorticoids, leading to excess morbidity and mortality. Diagnosis of this rare pathology is difficult due to the low specificity of the clinical signs, the variable severity of the clinical presentation, and the difficulties of interpretation associated with the diagnostic methods. The present consensus paper by 38 experts of the French Society of Endocrinology and the French Society of Pediatric Endocrinology and Diabetology aimed firstly to detail the circumstances suggesting diagnosis and the biologic diagnosis tools and their interpretation for positive diagnosis and for etiologic diagnosis according to ACTH-independent and -dependent mechanisms. Secondly, situations making diagnosis complex (pregnancy, intense hypercortisolism, fluctuating Cushing's syndrome, pediatric forms and genetically determined forms) were detailed. Lastly, methods of surveillance and diagnosis of recurrence were dealt with in the final section.
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Affiliation(s)
- Antoine Tabarin
- Service Endocrinologie, Diabète et Nutrition, Université, Hôpital Haut-Leveque CHU de Bordeaux, 33604 Pessac, France.
| | - Guillaume Assié
- Centre de Référence Maladies Rares de la Surrénale (CRMRS), Service d'Endocrinologie, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Pascal Barat
- Unité d'Endocrinologie-Diabétologie-Gynécologie-Obésité Pédiatrique, Hôpital des Enfants CHU Bordeaux, Bordeaux, France
| | - Fidéline Bonnet
- UF d'Hormonologie Hôpital Cochin, Université de Paris, Institut Cochin Inserm U1016, CNRS UMR8104, Paris, France
| | | | - Françoise Borson-Chazot
- Fédération d'Endocrinologie, Hôpital Louis-Pradel, Hospices Civils de Lyon, INSERM U1290, Université Lyon1, 69002 Lyon, France
| | - Jérôme Bouligand
- Faculté de Médecine Paris-Saclay, Unité Inserm UMRS1185 Physiologie et Physiopathologie Endocriniennes, Paris, France
| | - Anne Boulin
- Service de Neuroradiologie, Hôpital Foch, 92151 Suresnes, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Recherche Scientifique (INSERM) U1251, Marseille Medical Genetics, Marseille, France; Assistance publique-Hôpitaux de Marseille, Service d'Endocrinologie, Hôpital de la Conception, Centre de Référence Maladies Rares HYPO, 13005 Marseille, France
| | - Philippe Caron
- Service d'Endocrinologie et Maladies Métaboliques, Pôle Cardiovasculaire et Métabolique, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Frédéric Castinetti
- Aix-Marseille Université, Institut National de la Recherche Scientifique (INSERM) U1251, Marseille Medical Genetics, Marseille, France; Assistance publique-Hôpitaux de Marseille, Service d'Endocrinologie, Hôpital de la Conception, Centre de Référence Maladies Rares HYPO, 13005 Marseille, France
| | - Olivier Chabre
- Université Grenoble Alpes, UMR 1292 INSERM-CEA-UGA, Endocrinologie, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Le Kremlin-Bicêtre, France
| | - Jean Benoit Corcuff
- Laboratoire d'Hormonologie, Service de Médecine Nucléaire, CHU Bordeaux, Laboratoire NutriNeuro, UMR 1286 INRAE, Université de Bordeaux, Bordeaux, France
| | - Christine Cortet
- Service d'Endocrinologie, Diabétologie, Métabolisme et Nutrition, CHU de Lille, Lille, France
| | - Régis Coutant
- Service d'Endocrinologie Pédiatrique, CHU Angers, Centre de Référence, Centre Constitutif des Maladies Rares de l'Hypophyse, CHU Angers, Angers, France
| | - Anthony Dohan
- Department of Radiology A, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Delphine Drui
- Service Endocrinologie-Diabétologie et Nutrition, l'institut du Thorax, CHU Nantes, 44092 Nantes cedex, France
| | - Stéphanie Espiard
- Service d'Endocrinologie, Diabétologie, Métabolisme et Nutrition, INSERM U1190, Laboratoire de Recherche Translationnelle sur le Diabète, 59000 Lille, France
| | - Delphine Gaye
- Service de Radiologie, Hôpital Haut-Lêveque, CHU de Bordeaux, 33604 Pessac, France
| | - Solenge Grunenwald
- Service d'Endocrinologie, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | - Laurence Guignat
- Centre de Référence Maladies Rares de la Surrénale (CRMRS), Service d'Endocrinologie, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Elif Hindie
- Service de Médecine Nucléaire, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Frédéric Illouz
- Centre de Référence Maladies Rares de la Thyroïde et des Récepteurs Hormonaux, Service Endocrinologie-Diabétologie-Nutrition, CHU Angers, 49933 Angers cedex 9, France
| | - Peter Kamenicky
- Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Hervé Lefebvre
- Service d'Endocrinologie, Diabète et Maladies Métaboliques, CHU de Rouen, Rouen, France
| | - Agnès Linglart
- Paris-Saclay University, AP-HP, Endocrinology and Diabetes for Children, Reference Center for Rare Disorders of Calcium and Phosphate Metabolism, Filière OSCAR, and Platform of Expertise for Rare Disorders, INSERM, Physiologie et Physiopathologie Endocriniennes, Bicêtre Paris-Saclay Hospital, Le Kremlin-Bicêtre, France
| | - Laetitia Martinerie
- Service d'Endocrinologie Pédiatrique, CHU Robert-Debré, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Marie Odile North
- Service de Génétique et Biologie Moléculaire, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Marie Laure Raffin-Samson
- Service d'Endocrinologie Nutrition, Hôpital Ambroise-Paré, GHU Paris-Saclay, AP-HP Boulogne, EA4340, Université de Versailles-Saint-Quentin, Paris, France
| | - Isabelle Raingeard
- Maladies Endocriniennes, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Gérald Raverot
- Fédération d'Endocrinologie, Centre de Référence Maladies Rares Hypophysaires, "Groupement Hospitalier Est", Hospices Civils de Lyon, Lyon, France
| | - Véronique Raverot
- Hospices Civils de Lyon, LBMMS, Centre de Biologie Est, Service de Biochimie et Biologie Moléculaire, 69677 Bron cedex, France
| | - Yves Reznik
- Department of Endocrinology and Diabetology, CHU Côte-de-Nacre, 14033 Caen cedex, France; University of Caen Basse-Normandie, Medical School, 14032 Caen cedex, France
| | - David Taieb
- Aix-Marseille Université, CHU La Timone, AP-HM, Marseille, France
| | - Delphine Vezzosi
- Service d'Endocrinologie, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | - Jacques Young
- Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Jérôme Bertherat
- Centre de Référence Maladies Rares de la Surrénale (CRMRS), Service d'Endocrinologie, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
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21
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Clay MR, Pinto EM, Fishbein L, Else T, Kiseljak-Vassiliades K. Pathological and Genetic Stratification for Management of Adrenocortical Carcinoma. J Clin Endocrinol Metab 2022; 107:1159-1169. [PMID: 34850906 PMCID: PMC8947319 DOI: 10.1210/clinem/dgab866] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Indexed: 12/07/2022]
Abstract
CONTEXT Adrenocortical carcinoma (ACC) is a rare endocrine malignancy that affects patients across the age spectrum. Although the overall survival in patients with ACC is poor, there is significant heterogeneity in terms of outcomes, presentation, and underlying genetic drivers. EVIDENCE ACQUISITION This review is based on the evidence collected from primary research studies, expert reviews, and published guidelines. The studies were identified through PubMed search with key words "adrenocortical carcinoma," "prognosis," "pathology," and "genetics." The PubMed search was complemented by authors' expertise, research, and clinical experience in the field of ACC. EVIDENCE SYNTHESIS Identification of biomarkers has been critical to gain better insight into tumor behavior and to guide therapeutic approach to patients. Tumor stage, resection status, and Ki67 are pathological tumor characteristics that have been identified as prognosticators in patients with ACC. Cortisol excess also correlates with worse prognosis. Clinical and histopathological characteristics help stratify patient outcomes, yet still up to 25% of patients have a different outcome than predicted. To bridge this gap, comprehensive genomic profiling studies have characterized additional profiles that correlate with clinical outcomes. In addition, studies of clinically applicable molecular markers are under way to further stratify outcomes in patients with ACC tumors. CONCLUSIONS Clinical predictors in combination with pathological markers play a critical role in the approach to patients with ACC. Recent advances in genetic prognosticators will help extend the stratification of these tumors and contribute to a personalized therapeutic approach to patients with ACC.
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Affiliation(s)
- Michael R Clay
- Department of Pathology, University of Colorado School of Medicine at Colorado Anschutz Medical Campus Aurora, CO, USA
| | - Emilia M Pinto
- Department of Pathology; St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Lauren Fishbein
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine at Colorado Anschutz Medical Campus Aurora, CO, USA
| | - Tobias Else
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Katja Kiseljak-Vassiliades
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine at Colorado Anschutz Medical Campus Aurora, CO, USA
- Research Service Veterans Affairs Medical Center, Aurora, CO, USA
- Correspondence: Katja Kiseljak-Vassiliades, DO, Endocrinology MS8106, University of Colorado School of Medicine, 12801 East 17th Ave, RC1 South, Aurora, CO 80045, USA.
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22
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Mete O, Erickson LA, Juhlin CC, de Krijger RR, Sasano H, Volante M, Papotti MG. Overview of the 2022 WHO Classification of Adrenal Cortical Tumors. Endocr Pathol 2022; 33:155-196. [PMID: 35288842 PMCID: PMC8920443 DOI: 10.1007/s12022-022-09710-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 12/13/2022]
Abstract
The new WHO classification of adrenal cortical proliferations reflects translational advances in the fields of endocrine pathology, oncology and molecular biology. By adopting a question-answer framework, this review highlights advances in knowledge of histological features, ancillary studies, and associated genetic findings that increase the understanding of the adrenal cortex pathologies that are now reflected in the 2022 WHO classification. The pathological correlates of adrenal cortical proliferations include diffuse adrenal cortical hyperplasia, adrenal cortical nodular disease, adrenal cortical adenomas and adrenal cortical carcinomas. Understanding germline susceptibility and the clonal-neoplastic nature of individual adrenal cortical nodules in primary bilateral macronodular adrenal cortical disease, and recognition of the clonal-neoplastic nature of incidentally discovered non-functional subcentimeter benign adrenal cortical nodules has led to redefining the spectrum of adrenal cortical nodular disease. As a consequence, the most significant nomenclature change in the field of adrenal cortical pathology involves the refined classification of adrenal cortical nodular disease which now includes (a) sporadic nodular adrenocortical disease, (b) bilateral micronodular adrenal cortical disease, and (c) bilateral macronodular adrenal cortical disease (formerly known primary bilateral macronodular adrenal cortical hyperplasia). This group of clinicopathological entities are reflected in functional adrenal cortical pathologies. Aldosterone producing cortical lesions can be unifocal or multifocal, and may be bilateral with no imaging-detected nodule(s). Furthermore, not all grossly or radiologically identified adrenal cortical lesions may be the source of aldosterone excess. For this reason, the new WHO classification endorses the nomenclature of the HISTALDO classification which uses CYP11B2 immunohistochemistry to identify functional sites of aldosterone production to help predict the risk of bilateral disease in primary aldosteronism. Adrenal cortical carcinomas are subtyped based on their morphological features to include conventional, oncocytic, myxoid, and sarcomatoid subtypes. Although the classic histopathologic criteria for diagnosing adrenal cortical carcinomas have not changed, the 2022 WHO classification underscores the diagnostic and prognostic impact of angioinvasion (vascular invasion) in these tumors. Microscopic angioinvasion is defined as tumor cells invading through a vessel wall and forming a thrombus/fibrin-tumor complex or intravascular tumor cells admixed with platelet thrombus/fibrin. In addition to well-established Weiss and modified Weiss scoring systems, the new WHO classification also expands on the use of other multiparameter diagnostic algorithms (reticulin algorithm, Lin-Weiss-Bisceglia system, and Helsinki scoring system) to assist the workup of adrenal cortical neoplasms in adults. Accordingly, conventional carcinomas can be assessed using all multiparameter diagnostic schemes, whereas oncocytic neoplasms can be assessed using the Lin-Weiss-Bisceglia system, reticulin algorithm and Helsinki scoring system. Pediatric adrenal cortical neoplasms are assessed using the Wieneke system. Most adult adrenal cortical carcinomas show > 5 mitoses per 10 mm2 and > 5% Ki67. The 2022 WHO classification places an emphasis on an accurate assessment of tumor proliferation rate using both the mitotic count (mitoses per 10 mm2) and Ki67 labeling index which play an essential role in the dynamic risk stratification of affected patients. Low grade carcinomas have mitotic rate of ≤ 20 mitoses per 10 mm2, whereas high-grade carcinomas show > 20 mitoses per 10 mm2. Ki67-based tumor grading has not been endorsed in the new WHO classification, since the proliferation indices are continuous variables rather than being static thresholds in tumor biology. This new WHO classification emphasizes the role of diagnostic and predictive biomarkers in the workup of adrenal cortical neoplasms. Confirmation of the adrenal cortical origin of a tumor remains a critical requirement when dealing with non-functional lesions in the adrenal gland which may be mistaken for a primary adrenal cortical neoplasm. While SF1 is the most reliable biomarker in the confirmation of adrenal cortical origin, paranuclear IGF2 expression is a useful biomarker in the distinction of malignancy in adrenal cortical neoplasms. In addition to adrenal myelolipoma, the new classification of adrenal cortical tumors has introduced new sections including adrenal ectopia, based on the potential role of such ectopic tissue as a possible source of neoplastic proliferations as well as a potential mimicker of metastatic disease. Adrenal cysts are also discussed in the new classification as they may simulate primary cystic adrenal neoplasms or even adrenal cortical carcinomas in the setting of an adrenal pseudocyst.
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Affiliation(s)
- Ozgur Mete
- Department of Pathology, University Health Network, Toronto, ON, Canada.
- Endocrine Oncology Site, Princess Margaret Cancer Centre, Toronto, ON, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Ronald R de Krijger
- Princess Maxima Center for Pediatric Oncology, and Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hironobu Sasano
- Department of Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Marco Volante
- Department of Pathology, University of Turin, Turin, Italy
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23
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Mattone MC, Gil S, Costanzo M, Galluzzo Mutti ML, Casanovas A, Zaidman V, Lazzati JM, Ciaccio M, Belgorosky A, Guercio G. Pediatric adrenocortical tumors cohort characteristics and long-term follow-up at a single Argentinian tertiary center. J Pediatr Endocrinol Metab 2022; 35:19-27. [PMID: 34674406 DOI: 10.1515/jpem-2021-0392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/04/2021] [Indexed: 12/25/2022]
Abstract
UNLABELLED Pediatric adrenocortical tumors are rare and heterogeneous endocrine malignancies. OBJECTIVES To report clinical, biochemical, and histological features, staging, and therapeutic interventions in a cohort of 28 patients treated at a single tertiary center. METHODS A retrospective review of medical records of children with PACT (diagnosed before <18 years of age) followed between 1987-2018 at Hospital de Pediatría Garrahan, Buenos Aires, Argentina. RESULTS Mean age at diagnosis was 4.6 years (range, 0.3-17.3 years) and median follow-up was 4.17 years (range, 0-12 years). Female to male ratio was 2.5:1. Signs and symptoms that prompted medical intervention were hormonal overproduction (57%), abdominal complaints (36%), and hypertensive encephalopathy (7%). In patients with clinically virilizing tumors (n=16) mean height standard deviation score (SDS) and bone age advance were significantly higher while body mass index (BMI) SDS was significantly lower than in those with clinical Cushing's (n=10) (p<0.05). Serum dehydroepiandrosterone sulfate (DHEAS) levels were significantly higher in stage IV than in stage I (p=0.03). Total adrenalectomy was performed in 26 patients. Eight patients (stage III-IV) received adjuvant chemotherapy. Five-year overall and disease-free survival were 100% for ST I-II, and 51% (95% CI 21-82) and 33% (95% CI 1.2-65) for ST III-IV, respectively (p=0.002). No statistical difference was found when comparing 2-year parameters with and without adjuvant chemotherapy. CONCLUSIONS Height SDS and BMI SDS seem to mirror hormonal secretion in pediatric adrenocortical tumors. Higher DHEAS levels were found in patients with more advanced disease. Further large-scale studies are needed to validate a possible role for DHEAS as a biochemical marker of tumor stage and to draw robust conclusions on the use of adjuvant chemotherapy.
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Affiliation(s)
- María Celeste Mattone
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Silvia Gil
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | | | | | - Alejandra Casanovas
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
- Instituto Nacional del Cáncer, Buenos Aires, Argentina
| | | | | | - Marta Ciaccio
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | - Alicia Belgorosky
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Gabriela Guercio
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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24
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Ilanchezhian M, Varghese DG, Glod JW, Reilly KM, Widemann BC, Pommier Y, Kaplan RN, Del Rivero J. Pediatric adrenocortical carcinoma. Front Endocrinol (Lausanne) 2022; 13:961650. [PMID: 36387865 PMCID: PMC9659577 DOI: 10.3389/fendo.2022.961650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy of the adrenal gland with an unfavorable prognosis. It is rare in the pediatric population, with an incidence of 0.2-0.3 patients per million in patients under 20 years old. It is primarily associated with Li-Fraumeni and Beckwith-Wiedemann tumor predisposition syndromes in children. The incidence of pediatric ACC is 10-15fold higher in southern Brazil due to a higher prevalence of TP53 mutation associated with Li-Fraumeni syndrome in that population. Current treatment protocols are derived from adult ACC and consist of surgery and/or chemotherapy with etoposide, doxorubicin, and cisplatin (EDP) with mitotane. Limited research has been reported on other treatment modalities for pediatric ACC, including mitotane, pembrolizumab, cabozantinib, and chimeric antigen receptor autologous cell (CAR-T) therapy.
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Affiliation(s)
- Maran Ilanchezhian
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Diana Grace Varghese
- Developmental Therapeutics Branch, Rare Tumor Initiative, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - John W. Glod
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Karlyne M. Reilly
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Brigitte C. Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Yves Pommier
- Developmental Therapeutics Branch, Rare Tumor Initiative, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Rosandra N. Kaplan
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Jaydira Del Rivero
- Developmental Therapeutics Branch, Rare Tumor Initiative, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
- *Correspondence: Jaydira Del Rivero,
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25
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Tosin KCF, Legal EF, Pianovski MAD, Ibañez HC, Custódio G, Carvalho DS, Figueiredo MMO, Hoffmann Filho A, Fiori CMCM, Rodrigues ALM, Mello RG, Ogradowski KRP, Parise IZS, Costa TEJ, Melanda VS, Watanabe FM, Silva DB, Komechen H, Laureano HA, Carboni EK, Kuczynski AP, Luiz GCF, Lima L, Tormen T, Gerber VKQ, Anegawa TH, Avilla SGA, Tenório RB, Mendes EL, Fachin Donin RD, Souza J, Kozak VN, Oliveira GS, Souza DC, Gomy I, Teixeira VB, Borba HHL, Kiesel Filho N, Parise GA, Ribeiro RC, Figueiredo BC. Newborn Screening for the Detection of the TP53 R337H Variant and Surveillance for Early Diagnosis of Pediatric Adrenocortical Tumors: Lessons Learned and Way Forward. Cancers (Basel) 2021; 13:cancers13236111. [PMID: 34885220 PMCID: PMC8656743 DOI: 10.3390/cancers13236111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Adrenocortical tumor (ACT) is rare in children and fatal if not detected early. Children who inherit a mutation of the TP53 gene tend to develop ACT early in life. In the 1990s, scientists revealed that a TP53 variant (R337H) was frequent in South Brazil. Therefore, the incidence of ACT in children is 20 times higher in this region than in other countries. We reviewed the records of 16 children with ACT treated in a pediatric hospital in Parana state (southern Brazil) and 134 children registered in the state public registry data. We found a high number of cases with advanced disease, leading to an unacceptable number of deaths. These observations contradict newborn R337H screening and surveillance data, showing that surgical intervention in early cases of ACT is associated with a 100% cure. Newborn screening/surveillance should be implemented in regions with a high frequency of the R337H variant. Abstract The incidence of pediatric adrenocortical tumors (ACT) is high in southern Brazil due to the founder TP53 R337H variant. Neonatal screening/surveillance (NSS) for this variant resulted in early ACT detection and improved outcomes. The medical records of children with ACT who did not participate in newborn screening (non-NSS) were reviewed (2012–2018). We compared known prognostic factors between the NSS and non-NSS cohorts and estimated surveillance and treatment costs. Of the 16 non-NSS children with ACT carrying the R337H variant, the disease stages I, II, III, and IV were observed in five, five, one, and five children, respectively. The tumor weight ranged from 22 to 608 g. The 11 NSS children with ACT all had disease stage I and were alive. The median tumor weight, age of diagnosis, and interval between symptoms and diagnosis were 21 g, 1.9 years, and two weeks, respectively, for the NSS cohort and 210 g, 5.2 years, and 15 weeks, respectively, for the non-NSS cohort. The estimated surveillance/screening cost per year of life saved is US$623/patient. NSS is critical for improving the outcome of pediatric ACT in this region. Hence, we strongly advocate for the inclusion of R337H in the state-mandated universal screening and surveillance.
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Affiliation(s)
- Karina C. F. Tosin
- Departamento de Saúde Coletiva, Federal University of Paraná, Rua Padre Camargo, 260, Centro, Curitiba 80.060-240, PR, Brazil; (K.C.F.T.); (D.S.C.)
| | - Edith F. Legal
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
| | - Mara A. D. Pianovski
- Oncologia Pediátrica, Hospital Erasto Gaertner, R. Dr. Ovande do Amaral, 201, Jardim das Américas, Curitiba 81.520-060, PR, Brazil; (M.A.D.P.); (A.L.M.R.); (V.N.K.); (G.S.O.); (D.C.S.)
| | - Humberto C. Ibañez
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
| | - Gislaine Custódio
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC-APACN), Avenida Agostinho Leão Jr., 400, Curitiba 80.030-110, PR, Brazil; (G.C.); (M.M.O.F.); (R.D.F.D.); (G.A.P.)
| | - Denise S. Carvalho
- Departamento de Saúde Coletiva, Federal University of Paraná, Rua Padre Camargo, 260, Centro, Curitiba 80.060-240, PR, Brazil; (K.C.F.T.); (D.S.C.)
| | - Mirna M. O. Figueiredo
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC-APACN), Avenida Agostinho Leão Jr., 400, Curitiba 80.030-110, PR, Brazil; (G.C.); (M.M.O.F.); (R.D.F.D.); (G.A.P.)
| | - Anselmo Hoffmann Filho
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
| | - Carmem M. C. M. Fiori
- Hospital do Câncer, UOPECCAN, R. Itaquatiaras, 769, Santo Onofre, Cascavel 85.806-300, PR, Brazil;
| | - Ana Luiza M. Rodrigues
- Oncologia Pediátrica, Hospital Erasto Gaertner, R. Dr. Ovande do Amaral, 201, Jardim das Américas, Curitiba 81.520-060, PR, Brazil; (M.A.D.P.); (A.L.M.R.); (V.N.K.); (G.S.O.); (D.C.S.)
| | - Rosiane G. Mello
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Rebouças, Curitiba 80.230-020, PR, Brazil;
| | - Karin R. P. Ogradowski
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Rebouças, Curitiba 80.230-020, PR, Brazil;
| | - Ivy Z. S. Parise
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
| | - Tatiana E. J. Costa
- Hospital Infantil Joana de Gusmão, R. Rui Barbosa, 152, Agronômica, Florianópolis 88.025-301, SC, Brazil; (T.E.J.C.); (D.B.S.)
| | - Viviane S. Melanda
- Secretaria do Estado da Saúde do Paraná, R. Piquiri, 170, Rebouças, Curitiba 80.230-140, PR, Brazil;
| | - Flora M. Watanabe
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Denise B. Silva
- Hospital Infantil Joana de Gusmão, R. Rui Barbosa, 152, Agronômica, Florianópolis 88.025-301, SC, Brazil; (T.E.J.C.); (D.B.S.)
| | - Heloisa Komechen
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC-APACN), Avenida Agostinho Leão Jr., 400, Curitiba 80.030-110, PR, Brazil; (G.C.); (M.M.O.F.); (R.D.F.D.); (G.A.P.)
| | - Henrique A. Laureano
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
| | - Edna K. Carboni
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Ana P. Kuczynski
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Gabriela C. F. Luiz
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Leniza Lima
- Oncologia Pediátrica, Hospital de Clínicas da Universidade Federal do Paraná, R. Gen. Carneiro, 181, Alto da Glória, Curitiba 80.060-900, PR, Brazil; (L.L.); (T.T.)
| | - Tiago Tormen
- Oncologia Pediátrica, Hospital de Clínicas da Universidade Federal do Paraná, R. Gen. Carneiro, 181, Alto da Glória, Curitiba 80.060-900, PR, Brazil; (L.L.); (T.T.)
| | - Viviane K. Q. Gerber
- Departamento de Enfermagem, Universidade Estadual do Centro-Oeste, UNICENTRO, Rua Padre, R. Salvatore Renna, 875-Santa Cruz, Guarapuava 85.015-430, PR, Brazil;
| | - Tania H. Anegawa
- Oncologia Pediátrica, Campus Universitário, Universidade Estadual de Londrina, Rodovia Celso Garcia Cid—Pr 445 Km 380, Londrina 86.057-970, PR, Brazil;
| | - Sylvio G. A. Avilla
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Renata B. Tenório
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Elaine L. Mendes
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Rayssa D. Fachin Donin
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC-APACN), Avenida Agostinho Leão Jr., 400, Curitiba 80.030-110, PR, Brazil; (G.C.); (M.M.O.F.); (R.D.F.D.); (G.A.P.)
| | - Josiane Souza
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Vanessa N. Kozak
- Oncologia Pediátrica, Hospital Erasto Gaertner, R. Dr. Ovande do Amaral, 201, Jardim das Américas, Curitiba 81.520-060, PR, Brazil; (M.A.D.P.); (A.L.M.R.); (V.N.K.); (G.S.O.); (D.C.S.)
| | - Gisele S. Oliveira
- Oncologia Pediátrica, Hospital Erasto Gaertner, R. Dr. Ovande do Amaral, 201, Jardim das Américas, Curitiba 81.520-060, PR, Brazil; (M.A.D.P.); (A.L.M.R.); (V.N.K.); (G.S.O.); (D.C.S.)
| | - Deivid C. Souza
- Oncologia Pediátrica, Hospital Erasto Gaertner, R. Dr. Ovande do Amaral, 201, Jardim das Américas, Curitiba 81.520-060, PR, Brazil; (M.A.D.P.); (A.L.M.R.); (V.N.K.); (G.S.O.); (D.C.S.)
| | - Israel Gomy
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Rebouças, Curitiba 80.230-020, PR, Brazil;
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Vinicius B. Teixeira
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
| | - Helena H. L. Borba
- Departamento de Ciências Farmacêuticas, Federal University of Paraná, Av. Prefeito Lothário Meissner, 632-Jardim Botanico, Curitiba 80.210-170, PR, Brazil;
| | - Nilton Kiesel Filho
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Guilherme A. Parise
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC-APACN), Avenida Agostinho Leão Jr., 400, Curitiba 80.030-110, PR, Brazil; (G.C.); (M.M.O.F.); (R.D.F.D.); (G.A.P.)
| | - Raul C. Ribeiro
- Leukemia and Lymphoma Division, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Correspondence: (R.C.R.); or (B.C.F.)
| | - Bonald C. Figueiredo
- Departamento de Saúde Coletiva, Federal University of Paraná, Rua Padre Camargo, 260, Centro, Curitiba 80.060-240, PR, Brazil; (K.C.F.T.); (D.S.C.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC-APACN), Avenida Agostinho Leão Jr., 400, Curitiba 80.030-110, PR, Brazil; (G.C.); (M.M.O.F.); (R.D.F.D.); (G.A.P.)
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Rebouças, Curitiba 80.230-020, PR, Brazil;
- Correspondence: (R.C.R.); or (B.C.F.)
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Özcan HN, Tan AA, Ardıçlı B, Oguz B, Ekinci S, Kutluk T, Haliloglu M. Imaging findings of primary adrenal tumors in pediatric patients. DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY (ANKARA, TURKEY) 2021; 27:811-815. [PMID: 34792039 DOI: 10.5152/dir.2021.20701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Apart from neuroblastomas, adrenal tumors are rarely seen in children. The most common adrenal tumors are adrenocortical carcinoma and pheochromocytoma. Adrenocortical carcinoma is usually a large heterogeneous, well-marginated mass with solid/cystic areas and calcifications, with poor prognosis. Most of the pheochromocytomas are benign tumors and usually show intense contrast enhancement, the pattern of which may be diffuse, mottled, or peripheral on computed tomography and magnetic resonance imaging. The purpose of this article is to evaluate primary nonneurogenic adrenal tumors.
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Affiliation(s)
- H Nursun Özcan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Aziz Anıl Tan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Burak Ardıçlı
- Department of Pediatric Surgery, Hacettepe University School of Medicine Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Saniye Ekinci
- Department of Pediatric Surgery, Hacettepe University School of Medicine Ankara, Turkey
| | - Tezer Kutluk
- Division of Pediatric Oncology, Department of Pediatrics, Hacettepe University School of Medicine Ankara, Turkey
| | - Mithat Haliloglu
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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27
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Riedmeier M, Decarolis B, Haubitz I, Müller S, Uttinger K, Börner K, Reibetanz J, Wiegering A, Härtel C, Schlegel PG, Fassnacht M, Wiegering V. Adrenocortical Carcinoma in Childhood: A Systematic Review. Cancers (Basel) 2021; 13:5266. [PMID: 34771430 PMCID: PMC8582500 DOI: 10.3390/cancers13215266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 01/01/2023] Open
Abstract
Adrenocortical tumors are rare in children. This systematic review summarizes the published evidence on pediatric adrenocortical carcinoma (ACC) to provide a basis for a better understanding of the disease, investigate new molecular biomarkers and therapeutic targets, and define which patients may benefit from a more aggressive therapeutic approach. We included 137 studies with 3680 ACC patients (~65% female) in our analysis. We found no randomized controlled trials, so this review mainly reflects retrospective data. Due to a specific mutation in the TP53 gene in ~80% of Brazilian patients, that cohort was analyzed separately from series from other countries. Hormone analysis was described in 2569 of the 2874 patients (89%). Most patients were diagnosed with localized disease, whereas 23% had metastasis at primary diagnosis. Only 72% of the patients achieved complete resection. In 334 children (23%), recurrent disease was reported: 81%-local recurrence, 19% (n = 65)-distant metastases at relapse. Patients < 4 years old had a different distribution of tumor stages and hormone activity and better overall survival (p < 0.001). Although therapeutic approaches are typically multimodal, no consensus is available on effective standard treatments for advanced ACC. Thus, knowledge regarding pediatric ACC is still scarce and international prospective studies are needed to implement standardized clinical stratifications and risk-adapted therapeutic strategies.
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Affiliation(s)
- Maria Riedmeier
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children’s Hospital, University of Wuerzburg, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany; (M.R.); (I.H.); (C.H.); (P.-G.S.)
| | - Boris Decarolis
- Department of Pediatric Oncology and Hematology, Medical Faculty, University Children’s Hospital of Cologne, 50937 Cologne, Germany;
| | - Imme Haubitz
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children’s Hospital, University of Wuerzburg, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany; (M.R.); (I.H.); (C.H.); (P.-G.S.)
| | - Sophie Müller
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany; (S.M.); (K.U.); (K.B.); (J.R.); (A.W.)
| | - Konstantin Uttinger
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany; (S.M.); (K.U.); (K.B.); (J.R.); (A.W.)
| | - Kevin Börner
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany; (S.M.); (K.U.); (K.B.); (J.R.); (A.W.)
| | - Joachim Reibetanz
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany; (S.M.); (K.U.); (K.B.); (J.R.); (A.W.)
| | - Armin Wiegering
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany; (S.M.); (K.U.); (K.B.); (J.R.); (A.W.)
- Department of Biochemistry and Molecular Biology, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany;
| | - Christoph Härtel
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children’s Hospital, University of Wuerzburg, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany; (M.R.); (I.H.); (C.H.); (P.-G.S.)
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany;
| | - Paul-Gerhardt Schlegel
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children’s Hospital, University of Wuerzburg, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany; (M.R.); (I.H.); (C.H.); (P.-G.S.)
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany;
| | - Martin Fassnacht
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany;
- Department of Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany
| | - Verena Wiegering
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children’s Hospital, University of Wuerzburg, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany; (M.R.); (I.H.); (C.H.); (P.-G.S.)
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany;
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28
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Ziqin L, Yurui W, Xiaobo C, Jing L, Yuzhu L. Delayed Identification of Adolescent Adrenal Cortical Carcinoma Initially Diagnosed as Polycystic Ovary Syndrome. J Pediatr Adolesc Gynecol 2021; 34:764-767. [PMID: 33775909 DOI: 10.1016/j.jpag.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Adrenocortical carcinoma is a rare, isolated malignancy. CASE A 13-year-old girl presented with secondary amenorrhea, hirsutism, and hypertension. Her clinical manifestations were interpreted as polycystic ovary syndrome and hyperinsulinemia. The rapid progression of this pubertal girl's virilization should have, but did not draw clinical attention to her malignancy. Because her condition worsened, she ultimately was transferred to our hospital because of an abdominal mass. She was diagnosed with a very large adrenal cortical carcinoma with pulmonary metastasis. The child was in the advanced stage and presented adrenal crisis after chemotherapy and mitotane treatment. SUMMARY AND CONCLUSION Rapidly progressive masculinization, with a marked increase in adrenal-derived androgens, might indicate rare adrenal neoplasms.
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Affiliation(s)
- Liu Ziqin
- Department of Endocrinology, Capital Institute of Pediatrics, Beijing, China.
| | - Wu Yurui
- Department of Thoracic Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Chen Xiaobo
- Department of Endocrinology, Capital Institute of Pediatrics, Beijing, China
| | - Liu Jing
- Department of Thoracic Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Liu Yuzhu
- Department of Thoracic Surgery, Capital Institute of Pediatrics, Beijing, China
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29
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Brenna CTA, Michaeli O, Wasserman JD, Malkin D. Clinical Outcomes of Children With Adrenocortical Carcinoma in the Context of Germline TP53 Status. J Pediatr Hematol Oncol 2021; 43:e635-e641. [PMID: 33122580 DOI: 10.1097/mph.0000000000001982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/28/2020] [Indexed: 01/20/2023]
Abstract
Adrenocortical carcinoma (ACC) is a rare, aggressive malignancy of the adrenal cortex. This study characterizes a single-institution cohort of children treated for ACC, and explores the relationship between clinical outcomes of ACC and germline TP53 mutation status. We performed a retrospective chart review of 23 consecutive pediatric patients with ACC treated at The Hospital for Sick Children, Toronto, Canada, between 1977 and 2017. Clinical, biochemical, radiologic, pathologic, and genetic data were collected for each patient. ACC diagnosis followed a bimodal age distribution of 0 to 6 (n=17) and 12+ (n=6) years, with a female:male ratio of 3.6:1. Ten of 20 patients tested for germline TP53 status carried a pathogenic (9) or likely pathogenic (1) variant, including all but 1 male patient. Only 3 patients died of ACC-related causes, each 5 months post-diagnosis. When treated with resection and combination chemotherapy, carriers of germline TP53 mutations may respond more favorably than their wild-type counterparts. In addition, the survival of patients reported in our cohort with high-stage ACC was appreciably greater than previously described (100.0% for stage II, 50.0% for stage III, and 42.9% for stage IV), favoring aggressive intervention in these patient populations.
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Affiliation(s)
- Connor T A Brenna
- Departments of Medicine
- Program in Genetics and Genome Biology, The Hospital for Sick Children
| | - Orli Michaeli
- Pediatrics, University of Toronto
- Divisions of Hematology/Oncology
| | - Jonathan D Wasserman
- Pediatrics, University of Toronto
- Endocrinology, The Hospital for Sick Children Toronto, ON, Canada
| | - David Malkin
- Pediatrics, University of Toronto
- Program in Genetics and Genome Biology, The Hospital for Sick Children
- Divisions of Hematology/Oncology
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30
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Martins-Filho SN, Almeida MQ, Soares I, Wakamatsu A, Alves VAF, Fragoso MCBV, Zerbini MCN. Clinical Impact of Pathological Features Including the Ki-67 Labeling Index on Diagnosis and Prognosis of Adult and Pediatric Adrenocortical Tumors. Endocr Pathol 2021; 32:288-300. [PMID: 33443677 DOI: 10.1007/s12022-020-09654-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 10/22/2022]
Abstract
Adrenocortical tumors (ACT) in the adult and pediatric population are generally considered distinct entities due to differences in molecular events related to tumorigenesis, clinical presentation, and outcome. Furthermore, pathological criteria used for diagnosis and prognostication of ACT in adults are usually inadequate for predicting the biological behavior of ACT in children. Here, we analyzed 146 adult and 44 pediatric (< 15y/o) ACT with long-term clinical follow-up and furthered current evidence on the clinical and pathological differences between pediatric and adult tumors. Predilection for female over male gender was observed in both cohorts, but more so in adults (84% vs. 61%, p = 0.003). Cushing syndrome was more frequent in adults (p < 0.001), whereas virilization, either isolated (p < 0.001) or combined to Cushing (p = 0.047), was more common in children. The Ki67 labelling index (LI) of pediatric adenomas and carcinomas was much higher than their corresponding tumors in adults (p < 0.001). Despite these differences, pathological analyses including the evaluation of Ki67 greatly improved patient prognostication in both age cohorts. Indeed, increased Weiss scores and Ki67 indexes correlated with poor overall- and disease-free survival in adult patients with carcinoma. Among the proliferative indexes tested, Ki67 LI ≥ 10% showed the highest hazard ratio (HR) for recurrence and the Ki67 LI ≥ 3% showed the highest HR for survival. In pediatric tumors, the Wieneke score (p < 0.001) and the Ki67 LI (p < 0.001) showed high accuracy for predicting biological behavior, and increased scores/indexes correlated with worse overall and disease-free survival. In this age cohort, Ki67 LI < 10% was able to rule out malignant behavior, whereas Ki67 LI ≥ 15% may be used to predict the patients with higher risks of recurrence and/or poor outcome.
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Affiliation(s)
- Sebastiao N Martins-Filho
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
- Department of Pathology and Laboratory Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Madson Q Almeida
- Divisão de Endocrinologia, Laboratório de Hormônios E Genética Molecular LIM42, Faculdade de Medicina FMUSP, Hospital das Clínicas, São Paulo, Brazil
- Serviço de Oncologia Endócrina, Instituto Do Câncer Do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Ibere Soares
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Alda Wakamatsu
- Laboratório de Patologia Do Fígado LIM 14, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Venancio Avancini F Alves
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Patologia Do Fígado LIM 14, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Candida Barisson V Fragoso
- Divisão de Endocrinologia, Laboratório de Hormônios E Genética Molecular LIM42, Faculdade de Medicina FMUSP, Hospital das Clínicas, São Paulo, Brazil
- Serviço de Oncologia Endócrina, Instituto Do Câncer Do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Maria Claudia N Zerbini
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
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31
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Virgone C, Roganovic J, Vorwerk P, Redlich A, Schneider DT, Janic D, Bien E, López-Almaraz R, Godzinski J, Osterlundh G, Stachowicz-Stencel T, Brugières L, Brecht IB, Thomas-Teinturier C, Fresneau B, Surun A, Ferrari A, Bisogno G, Orbach D. Adrenocortical tumours in children and adolescents: The EXPeRT/PARTNER diagnostic and therapeutic recommendations. Pediatr Blood Cancer 2021; 68 Suppl 4:e29025. [PMID: 34174161 DOI: 10.1002/pbc.29025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/02/2021] [Accepted: 03/07/2021] [Indexed: 11/12/2022]
Abstract
Adrenocortical tumours (ACTs) are rare during childhood. A complete surgical resection provides the best chance of cure, but the role and efficacy of the adjuvant therapy are still controversial. Various histologic criteria of malignancy for ACTs adopted in children do not facilitate comparative studies and are not completely shared. Therefore, a sharp demarcation between benign and malignant lesions has not been recognised, making it difficult to identify who potentially needs perioperative therapy. This manuscript presents the internationally harmonised recommendations for the diagnosis and treatment of ACTs in children and adolescents, established by the European Cooperative Study Group for Paediatric Rare Tumours (EXPeRT) group within the EU-funded project PARTNER (Paediatric Rare Tumours Network - European Registry).
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Affiliation(s)
- Calogero Virgone
- Pediatric Surgery, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Jelena Roganovic
- Department of Pediatrics, Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Peter Vorwerk
- Pediatric Oncology Department, Otto von Guericke University Children´s Hospital, Magdeburg, Germany
| | - Antje Redlich
- Pediatric Oncology Department, Otto von Guericke University Children´s Hospital, Magdeburg, Germany
| | | | - Dragana Janic
- Department of Hematology and Oncology, University Children's Hospital, University of Belgrade, Belgrade, Serbia
| | - Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - Ricardo López-Almaraz
- Pediatric Hematology and Oncology Unit, Hospital Universitario de Cruces, Barakaldo-Bizkaia, Spain
| | - Jan Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw, Poland.,Department of Pediatric Traumatology and Emergency Medicine, Medical University, Wroclaw, Poland
| | - Gustaf Osterlundh
- Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden
| | | | - Laurence Brugières
- Gustave Roussy Cancer Center, Department of Children and Adolescents Oncology, Paris-Saclay University, Villejuif, France
| | - Ines B Brecht
- Pediatric Oncology and Hematology, University Children's Hospital, Tuebingen, Germany
| | - Cécile Thomas-Teinturier
- Assistance Publique Hôpitaux de Paris (APHP), Department of Endocrinology and Diabetes for Children, Bicêtre Paris-Sud, Le Kremlin Bicêtre, Paris, France
| | - Brice Fresneau
- Gustave Roussy Cancer Center, Department of Children and Adolescents Oncology, Paris-Saclay University, Villejuif, France.,Paris-Saclay University, Paris-Sud University, Paris, France
| | - Aurore Surun
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Gianni Bisogno
- Hematology-Oncology Division, Department of Women's and Children's Health, University Hospital, Padua, Italy
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
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32
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Patel S, Vogel J, Bradley K, Chuba PJ, Buchsbaum J, Krasin MJ. Rare tumors: Retinoblastoma, nasopharyngeal cancer, and adrenocorticoid tumors. Pediatr Blood Cancer 2021; 68 Suppl 2:e28253. [PMID: 33818883 DOI: 10.1002/pbc.28253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 11/11/2022]
Abstract
The role of surgery, chemotherapy, and radiation therapy for retinoblastoma has evolved considerably over the years with the efficacy of intraarterial chemotherapy and the high incidence of secondary malignant neoplasms following radiation therapy. The use of spot scanning intensity-modulated proton therapy may reduce the risk of secondary malignancies. For pediatric nasopharyngeal carcinoma, the current standard of care is induction chemotherapy followed by chemoradiation therapy. For adrenocortical carcinoma, the mainstay of treatment is surgery and chemotherapy. The role of radiation therapy remains to be defined.
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Affiliation(s)
- Samir Patel
- Divisions of Radiation Oncology and Pediatric Hematology, Oncology and Palliative Care, University of Alberta, Stollery Children's Hospital, Edmonton, Canada
| | - Jennifer Vogel
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristin Bradley
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Paul J Chuba
- Department of Radiation Oncology, St. John Providence Health Systems Webber Cancer Center, Warren, Michigan
| | - Jeffrey Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Matthew J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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33
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Rodriguez-Galindo C, Krailo MD, Pinto EM, Pashankar F, Weldon CB, Huang L, Caran EM, Hicks J, McCarville MB, Malkin D, Wasserman JD, de Oliveira Filho AG, LaQuaglia MP, Ward DA, Zambetti G, Mastellaro MJ, Pappo AS, Ribeiro RC. Treatment of Pediatric Adrenocortical Carcinoma With Surgery, Retroperitoneal Lymph Node Dissection, and Chemotherapy: The Children's Oncology Group ARAR0332 Protocol. J Clin Oncol 2021; 39:2463-2473. [PMID: 33822640 DOI: 10.1200/jco.20.02871] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Adrenocortical carcinoma (ACC) is a rare aggressive pediatric malignancy with distinct biology. Its treatment follows the principles developed for adults; pediatric-specific studies are scarce. PATIENTS AND METHODS Prospective single-arm risk-stratified interventional study. Study objectives were (1) to describe the outcome of patients with stage I ACC treated with adrenalectomy alone; (2) to describe the outcome of stage II patients (completely resected > 200 cc or > 100 g) treated with adrenalectomy and retroperitoneal lymph node dissection; and (3) to describe the outcome of patients with stage III or IV treated with mitotane and chemotherapy. RESULTS Between September 2006 and May 2013, 78 patients (77 eligible, 51 females) were enrolled. The 5-year event-free survival estimates for stages I (24 patients), II (15 patients), III (24 patients), and IV (14 patients) were 86.2%, 53.3%, 81%, and 7.1%, respectively. The corresponding 5-year overall survival estimates were 95.2%, 78.8%, 94.7%, and 15.6%, respectively. On univariate analysis, age, stage, presence of virilization, Cushing syndrome, or hypertension, germline TP53 status, and presence of a somatic ATRX mutation were associated with outcome. On multivariable analysis, only stage and age were significantly associated with outcome. The probabilities of mitotane and chemotherapy feasibility events were 10.5% and 31.6%, respectively. CONCLUSION Outcome for children with stage I ACC is excellent with surgery. Outcome for patients with stage II disease is inferior despite retroperitoneal lymph node dissection. Patients with stage III ACC have an excellent outcome combining surgery and chemotherapy. Patients with stage IV ACC are older and have a poor outcome; new treatments should be explored for this high-risk group. The combination of mitotane and chemotherapy as prescribed in ARAR0332 resulted in significant toxicity; one third of patients with advanced disease could not complete the scheduled treatment.
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Affiliation(s)
- Carlos Rodriguez-Galindo
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN.,Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Mark D Krailo
- Statistics and Data Center, Children's Oncology Group, Monrovia, CA.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Emilia M Pinto
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN
| | - Farzana Pashankar
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | | | - Li Huang
- Statistics and Data Center, Children's Oncology Group, Monrovia, CA
| | - Eliana M Caran
- Department of Oncology, Instituto de Oncologia Pediatrica, São Paulo, Brazil
| | - John Hicks
- Department of Pathology, Texas Children's Hospital, Houston, TX
| | - M Beth McCarville
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN
| | - David Malkin
- Division of Hematology-Oncology, Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | | | - Michael P LaQuaglia
- Department of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Deborah A Ward
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN
| | - Gerard Zambetti
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Alberto S Pappo
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Raul C Ribeiro
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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34
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Zambaiti E, Duci M, De Corti F, Gamba P, Dall'Igna P, Ghidini F, Virgone C. Clinical prognostic factors in pediatric adrenocortical tumors: A meta-analysis. Pediatr Blood Cancer 2021; 68:e28836. [PMID: 33306282 DOI: 10.1002/pbc.28836] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/27/2020] [Accepted: 11/14/2020] [Indexed: 12/14/2022]
Abstract
Pediatric adrenocortical tumors (ACT) are rare and sometimes aggressive malignancies, but there is no consensus on the outcome predictors in children. A systematic search of MEDLINE, SCOPUS, Web of Science, and the Cochrane Library for studies from 1994 to 2020 about pediatric ACT was performed. In 42 studies, 1006 patients, aged 0-18 years, were included. The meta-analyses resulted in the following predictors of better outcome: age <4 years (P < .00001), nonsecreting tumors (P = .004), complete surgical resection (P < .00001), tumor volume (P < .0001), tumor weight (P < .00001), tumor maximum diameter (P = .0009), and Stage I disease (P < .00001). Moreover, patients affected by Cushing syndrome showed a worse outcome (P < .0001). International prospective studies should be implemented to standardize clinical prognostic factors evaluation, together with pathological scores, in the stratification of pediatric ACT.
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Affiliation(s)
- Elisa Zambaiti
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Miriam Duci
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Federica De Corti
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Piergiorgio Gamba
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Patrizia Dall'Igna
- Department of Emergencies and Organ Transplantation, Azienda Ospedaliero-Universitaria Consorziale Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Filippo Ghidini
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Calogero Virgone
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
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35
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Lam AKY. Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging. Biomedicines 2021; 9:biomedicines9020175. [PMID: 33578929 PMCID: PMC7916702 DOI: 10.3390/biomedicines9020175] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 12/20/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a heterogenous group of diseases with different clinical behaviour between adult and paediatric patients. In addition, three histological variants, oncocytic, myxoid and sarcomatoid are noted on the recent World Health Organisation (WHO) classification of ACC. A review of recent literature showed that the different types of ACC have distinctive demographic data, clinical presentation, pathology, biological behaviour, genomic and patients' prognosis. In addition, recent updates of pathology staging for ACC allow refinement of prognostic grouping for planning treatment of the patients with ACC. These advances in genomic, pathology and staging have driven the development of standardisation of pathology reporting. International standardisation of pathological reporting of adrenocortical carcinoma and adaption to local pathology communities provide universal platforms for clinicians and researchers involved in the management of patients with ACC. To conclude, all these advances in the field of pathology will improve development of management strategies including improvement of clinical care, development of prognostic markers and testing of novel therapeutic approaches for patients with adrenocortical carcinoma.
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Affiliation(s)
- Alfred King-yin Lam
- School of Medicine, Griffith University, Gold Coast, QLD 4222, Australia;
- Pathology Queensland, Gold Coast University Hospital, Southport, Gold Coast, QLD 4215, Australia
- Faculty of Medicine, The University of Queensland, Herston, Brisbane, QLD 4006, Australia
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36
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Pinto EM, Rodriguez-Galindo C, Lam CG, Ruiz RE, Zambetti GP, Ribeiro RC. Adrenocortical Tumors in Children With Constitutive Chromosome 11p15 Paternal Uniparental Disomy: Implications for Diagnosis and Treatment. Front Endocrinol (Lausanne) 2021; 12:756523. [PMID: 34803919 PMCID: PMC8602920 DOI: 10.3389/fendo.2021.756523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Pediatric adrenocortical tumors (ACTs) are rare and heterogeneous. Approximately 50% of children with ACT carry a germline TP53 variant; however, the genetic underpinning of remaining cases has not been elucidated. In patients having germline TP53 variants, loss of maternal chromosome 11 and duplication of the paternal copy [paternal uniparental disomy, (UPD)] occurs early in tumorigenesis and explains the overexpression of IGF2, the hallmark of pediatric ACT. Beckwith-Wiedemann syndrome (BWS) is also associated with overexpression of IGF2 due to disruption of the 11p15 loci, including segmental UPD. Here, we report six children with ACT with wild type TP53 and germline paternal 11p15 UPD. Median age of five girls and one boy was 3.2 years (range 0.5-11 years). Two patients met the criteria for BWS before diagnosis of ACT. However, ACT was the first and only manifestation of paternal 11p15 UPD in four children. Tumor weight ranged from 21.5 g to 550 g. Despite poor prognostic features at presentation, such as pulmonary metastasis, bilateral adrenal involvement, and large tumors, all patients are alive 8-21 years after cancer diagnosis. Our observations suggest that children with ACT and wild type TP53, irrespective of their age, should be screened for germline abnormalities in chromosome 11p15.
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Affiliation(s)
- Emilia Modolo Pinto
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, United States
- *Correspondence: Emilia Modolo Pinto,
| | - Carlos Rodriguez-Galindo
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Catherine G. Lam
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Robert E. Ruiz
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Gerard P. Zambetti
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Raul C. Ribeiro
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
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37
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Miele E, Di Giannatale A, Crocoli A, Cozza R, Serra A, Castellano A, Cacchione A, Cefalo MG, Alaggio R, De Pasquale MD. Clinical, Genetic, and Prognostic Features of Adrenocortical Tumors in Children: A 10-Year Single-Center Experience. Front Oncol 2020; 10:554388. [PMID: 33178583 PMCID: PMC7593337 DOI: 10.3389/fonc.2020.554388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022] Open
Abstract
Background and Aims: Pediatric adrenocortical tumors (ACTs) are very rare endocrine neoplasms in childhood. In this study, we performed a retrospective analysis of children with ACT treated at our institution by examining clinical and genetic disease features, treatment strategies, and outcomes. Methods: We retrospectively analyzed a cohort of 13 children treated at the Bambino Gesù Children's Hospital from November 2010 to March 2020. Results: The median age at diagnosis was 17 months (range = 0–82 months). The female: male ratio was 3.3/1. Mixed symptomatology (>1 hormone abnormality) was the most common presentation (46.1%). In three cases, the tumor was detected during prenatal or perinatal echographic screening. All patients presented with localized disease at diagnosis and underwent total adrenalectomy. Six patients were identified as having malignancies according to the Wieneke scoring system, five benign, and two undetermined. Seven patients underwent mitotane adjuvant therapy for 12 months. There was metastatic disease in three patients, with no correlation with age or Wieneke score. The most common sites of metastases were the liver and lungs. Metastatic patients were treated with surgery (n = 2), mitotane (n = 1), chemotherapy (n = 2) associated with anti-EGFR (n = 1), or immunotherapy with anti-PD1 (pembrolizumab) (n = 1); two patients achieved complete disease remission. Overall 2- and 5-year survival rates were 100%, with a median follow-up of 5 years (range = 2–9.5 years). Two- and 5-year disease free survival was 76.9 and 84.6%, respectively (95% confidence interval = −66.78–114.76 months). All patients are alive, 12 without disease, and one with stable disease. Genetic analyses showed TP53 germline mutations in six of eight patients analyzed (five inherited, one de novo). One patient had Beckwith–Wiedemann syndrome, with mosaic paternal uniparental disomy of chromosome 11, in both neoplastic and healthy adrenal tissue. Conclusion: We report the cases of 13 patients treated for ACT, including 12 aged <4 years at diagnosis, with a relative short time from symptoms onset. Our cohort experienced an excellent prognosis. TP53 mutation was found in 75% of tested patients (6/8) confirming the need to perform genetic tests and familial counseling in this disease.
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Affiliation(s)
- Evelina Miele
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Di Giannatale
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Crocoli
- Department of Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Raffaele Cozza
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annalisa Serra
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Aurora Castellano
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonella Cacchione
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Giuseppina Cefalo
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rita Alaggio
- Department of Laboratories, Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Debora De Pasquale
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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38
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Chehade M, Bullock M, Glover A, Hutvagner G, Sidhu S. Key MicroRNA's and Their Targetome in Adrenocortical Cancer. Cancers (Basel) 2020; 12:E2198. [PMID: 32781574 PMCID: PMC7465134 DOI: 10.3390/cancers12082198] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 12/23/2022] Open
Abstract
Adrenocortical Carcinoma (ACC) is a rare but aggressive malignancy with poor prognosis and limited response to available systemic therapies. Although complete surgical resection gives the best chance for long-term survival, ACC has a two-year recurrence rate of 50%, which poses a therapeutic challenge. High throughput analyses focused on characterizing the molecular signature of ACC have revealed specific micro-RNAs (miRNAs) that are associated with aggressive tumor phenotypes. MiRNAs are small non-coding RNA molecules that regulate gene expression by inhibiting mRNA translation or degrading mRNA transcripts and have been generally implicated in carcinogenesis. This review summarizes the current insights into dysregulated miRNAs in ACC tumorigenesis, their known functions, and specific targetomes. In addition, we explore the possibility of particular miRNAs to be exploited as clinical biomarkers in ACC and as potential therapeutics.
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Affiliation(s)
- Marthe Chehade
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia; (M.C.); (M.B.); (A.G.)
- Sydney Medical School Northern, Royal North Shore Hospital, University of Sydney, Sydney, NSW 2065, Australia
| | - Martyn Bullock
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia; (M.C.); (M.B.); (A.G.)
- Sydney Medical School Northern, Royal North Shore Hospital, University of Sydney, Sydney, NSW 2065, Australia
| | - Anthony Glover
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia; (M.C.); (M.B.); (A.G.)
- Sydney Medical School Northern, Royal North Shore Hospital, University of Sydney, Sydney, NSW 2065, Australia
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St. Leonards, Sydney, NSW 2007, Australia
| | - Gyorgy Hutvagner
- School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Stan Sidhu
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia; (M.C.); (M.B.); (A.G.)
- Sydney Medical School Northern, Royal North Shore Hospital, University of Sydney, Sydney, NSW 2065, Australia
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St. Leonards, Sydney, NSW 2007, Australia
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39
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Abstract
Adrenocortical neoplasms are rare in childhood. Unlike their adult counterparts, they are often hormonally active and malignant. Despite being uncommon, adrenocortical neoplasms in children have significant associated morbidity and require complete surgical resection for effective management. Furthermore, the clinical overlap between adrenocortical neoplasms, adrenal medullary neoplasms, and functional disorders of the adrenal cortex requires that the practicing pediatric surgeon have a solid working knowledge of the presentation, diagnostic workup, and management of these anatomically related yet disparate pathologies.
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40
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Tripathy PK, Pattnaik K, Jena PK, Mohanty HK. Adrenal Tumors in Children: Spectrum of Presentation and Surgical Approach in a Tertiary Care Institute. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_176_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Context: Adrenal tumors can arise either from cortex or from medulla; both the regions being structurally and functionally different. Current knowledge on childhood adrenocortical tumors (ACTs), the management approach, and the outcome is limited due to limited number of cases and studies. Neuroblastoma is a neoplasm of the neural crest origin and 50% arise from adrenal medulla. Pheochromocytoma (PCC) is an exciting and rare neoplasm in childhood. Aims: To evaluate the clinical presentation, spectrum of pathology, and management of adrenal tumors in children. Subjects and Methods: The study was conducted in a tertiary care pediatric institute over 5 years on children with intra-abdominal solid tumors. Adrenal tumors were diagnosed on radiological studies and postoperatively confirmed by histopathology. Results: Sixty-three patients were operated for intra-abdominal solid tumors, and Wilms tumor (39) was the most common finding. Of 11 cases of adrenal tumors confirmed by histopathology, eight were adrenal neuroblastoma, one 14-month-old female baby was detected as PCC, while two female children presented with the features of Cushing syndrome and virilization at the age of 3 and 7 years. Postoperatively, one of them was found to be adrenal adenoma and one was found to be adrenocortical carcinoma. Conclusions: ACTs are rare and potentially fatal in childhood. Complete surgical resection is the mainstay of therapy in adrenal tumors and is curative for associated hypertension. Neuroblastoma was the third common intra-abdominal solid tumor after Wilms tumor and retroperitoneal teratoma. The patient with PCC contributed to “Rule of 10s” because of the absence of hypertension and childhood occurrence.
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Affiliation(s)
- Prasanta Kumar Tripathy
- Department of Pediatric Surgery, SVP PG Institute of Pediatrics, SCB Medical College, Cuttack, Odisha
| | | | - Pradeep Kumar Jena
- Department of Pediatric Surgery, SVP PG Institute of Pediatrics, SCB Medical College, Cuttack, Odisha
| | - Hiranya Kishor Mohanty
- Department of Pediatric Surgery, SVP PG Institute of Pediatrics, SCB Medical College, Cuttack, Odisha
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41
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Abstract
Childhood adrenocortical tumors (ACTs) are rare, representing ∼0.2% of all pediatric malignancies and having an incidence of 0.2-0.3 new cases per million per year in the United States, but incidences are remarkably higher in Southern Brazil. At diagnosis, most children show signs and symptoms of virilization, Cushing syndrome, or both. Less than 10% of patients with ACT exhibit no endocrine syndrome at presentation, although some show abnormal concentrations of adrenal cortex hormones. Pediatric ACT is commonly associated with constitutional genetic and/or epigenetic alterations, represented by germline TP53 mutations or chromosome 11p abnormalities. Complete tumor resection is required to achieve cure. The role of chemotherapy is not established, although definitive responses to several anticancer drugs are documented. For patients undergoing complete tumor resection, favorable prognostic factors include young age, small tumor size, virilization, and adenoma histology. Prospective studies are necessary to further elucidate the pathogenesis of ACT and improve patient outcomes.
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42
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Zheng J, Cai J, Diao X, Kong J, Chen X, Yu H, Xie W, Huang J, Lin T. Nomograms for the Prediction of Survival for Patients with Pediatric Adrenal Cancer after Surgery. J Cancer 2020; 11:2080-2090. [PMID: 32127935 PMCID: PMC7052927 DOI: 10.7150/jca.36861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 12/26/2019] [Indexed: 11/06/2022] Open
Abstract
Purpose: To develop and validate a nomogram to postoperatively evaluate overall survival (OS) and cancer-specific survival (CSS) in patients with pediatric adrenal cancer. Methods: In total, 847 eligible patients diagnosed between 1988 and 2015 form the Surveillance Epidemiology, and End Results (SEER) database were enrolled in this study according to the specified inclusion and exclusion criteria. They were divided into a training set (n = 661) and a validation set (n = 186). Multivariate Cox proportional hazards regression algorithm was used to identify the independent predictors of OS and CSS in the training set, and develop the predicting models, which were presented two nomograms. The performance of the nomograms (discrimination, calibration and clinical usefulness) was assessed in the training set and validated in the validation set. Results: Based on the multivariate Cox proportional hazards regression analyses, three independent predictors including age at diagnosis, tumor size and M stage were identified for both OS and CSS. Then, an OS nomogram and a CSS nomogram were developed incorporating these three predictors, respectively. The OS nomogram showed good calibration and discrimination in the training set (C-index [95% CI], 0.744 [0.711-0.777]), which was confirmed in the validation set (C-index [95% CI], 0.746 [0.656-0.836]). Favorable calibration and discrimination of the CSS nomogram were also observed in the training set (C-index [95% CI], 0.749 [0.715-0.783]) and validation set (C-index [95% CI], 0.789 [0.710-0.868]). Moreover, the nomograms successfully distinguished patients with high risk of all-cause and cancer-specific mortality in all patients and in the stratified analyses. Decision curve analysis demonstrated the usefulness of the nomograms. Conclusion: The presented nomograms show favorable predictive accuracy for OS and CSS in patients with pediatric adrenal cancer after surgery. Further validation is warranted prior to clinical implementation.
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Affiliation(s)
- Junjiong Zheng
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jinhua Cai
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiayao Diao
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jianqiu Kong
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiong Chen
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Hao Yu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Weibin Xie
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jian Huang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Tianxin Lin
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China
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Kong J, Zheng J, Cai J, Wu S, Diao X, Xie W, Chen X, Liao C, Yu H, Fan X, Huang C, Liu Z, Chen W, Lv Q, Qin H, Huang J, Lin T. A nomogram for individualized estimation of survival among adult patients with adrenocortical carcinoma after surgery: a retrospective analysis and multicenter validation study. Cancer Commun (Lond) 2019; 39:80. [PMID: 31775884 PMCID: PMC6882048 DOI: 10.1186/s40880-019-0426-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background Clinical outcome of adrenocortical carcinoma (ACC) varies because of its heterogeneous nature and reliable prognostic prediction model for adult ACC patients is limited. The objective of this study was to develop and externally validate a nomogram for overall survival (OS) prediction in adult patients with ACC after surgery. Methods Based on the data from the Surveillance Epidemiology, and End Results (SEER) database, adults patients diagnosed with ACC between January 1988 and December 2015 were identified and classified into a training set, comprised of 404 patients diagnosed between January 2007 and December 2015, and an internal validation set, comprised of 318 patients diagnosed between January 1988 and December 2006. The endpoint of this study was OS. The nomogram was developed using a multivariate Cox proportional hazards regression algorithm in the training set and its performance was evaluated in terms of its discriminative ability, calibration, and clinical usefulness. The nomogram was then validated using the internal SEER validation, also externally validated using the Cancer Genome Atlas set (TCGA, 82 patients diagnosed between 1998 and 2012) and a Chinese multicenter cohort dataset (82 patients diagnosed between December 2002 and May 2018), respectively. Results Age at diagnosis, T stage, N stage, and M stage were identified as independent predictors for OS. A nomogram incorporating these four predictors was constructed using the training set and demonstrated good calibration and discrimination (C-index 95% confidence interval [CI], 0.715 [0.679–0.751]), which was validated in the internal validation set (C-index [95% CI], 0.672 [0.637–0.707]), the TCGA set (C-index [95% CI], 0.810 [0.732–0.888]) and the Chinese multicenter set (C-index [95% CI], 0.726 [0.633–0.819]), respectively. Encouragingly, the nomogram was able to successfully distinguished patients with a high-risk of mortality in all enrolled patients and in the subgroup analyses. Decision curve analysis indicated that the nomogram was clinically useful and applicable. Conclusions The study presents a nomogram that incorporates clinicopathological predictors, which can accurately predict the OS of adult ACC patients after surgery. This model and the corresponding risk classification system have the potential to guide therapy decisions after surgery.
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Affiliation(s)
- Jianqiu Kong
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, 510120, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P. R. China
| | - Junjiong Zheng
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, 510120, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P. R. China
| | - Jinhua Cai
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P. R. China
| | - Shaoxu Wu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, 510120, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P. R. China
| | - Xiayao Diao
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, 510120, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P. R. China
| | - Weibin Xie
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, 510120, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P. R. China
| | - Xiong Chen
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, 510120, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P. R. China
| | - Chenyi Liao
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, P. R. China
| | - Hao Yu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, 510120, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P. R. China
| | - Xinxiang Fan
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, 510120, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P. R. China
| | - Chaowen Huang
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Zhuowei Liu
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Wei Chen
- Department of Urology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China
| | - Qiang Lv
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, P. R. China
| | - Haide Qin
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, 510120, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, 510120, Guangdong, P. R. China
| | - Jian Huang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, 510120, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P. R. China
| | - Tianxin Lin
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, 510120, Guangdong, P. R. China. .,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P. R. China. .,State Key Laboratory of Oncology in South China, Guangzhou, 510120, Guangdong, P. R. China.
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Parise IZS, Parise GA, Noronha L, Surakhy M, Woiski TD, Silva DB, Costa TEIJB, Del-Valle MHCP, Komechen H, Rosati R, Ribeiro MG, Nascimento ML, de Souza JA, Andrade DP, Paraizo MM, Galvão MMR, Barbosa JRS, Barbosa ML, Custódio GC, Figueiredo MMO, Fabro ALMR, Bond G, Volante M, Lalli E, Figueiredo BC. The Prognostic Role of CD8 + T Lymphocytes in Childhood Adrenocortical Carcinomas Compared to Ki-67, PD-1, PD-L1, and the Weiss Score. Cancers (Basel) 2019; 11:cancers11111730. [PMID: 31694270 PMCID: PMC6896110 DOI: 10.3390/cancers11111730] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/25/2019] [Accepted: 11/01/2019] [Indexed: 12/24/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare disease among children. Our goal was to identify prognostic biomarkers in 48 primary ACCs from children (2.83 ± 2.3 y; mean age ± SD) by evaluating the tumor stage and outcome for an age of diagnosis before or after 3 years, and association with ACC cluster of differentiation 8 positive (CD8+) cytotoxic T lymphocytes (CD8+-CTL) and Ki-67 immunohistochemical expression (IHC). Programmed death 1(PD-1)/Programmed death-ligand 1 (PD-L1) immunohistochemistry (IHC) in ACC was analyzed in a second, partially overlapping cohort (N = 19) with a similar mean age. All patients and control children were carriers of the germline TP53 R337H mutation. Survival without recurrence for less than 3 years and death unrelated to disease were excluded. Higher counts of CD8+-CTL were associated with patients diagnosed with ACC at a younger age and stage I, whereas a higher percentage of the Ki-67 labeling index (LI) and Weiss scores did not differentiate disease free survival (DFS) in children younger than 3 years old. No PD-1 staining was observed, whereas weakly PD-L1-positive immune cells were found in 4/19 (21%) of the ACC samples studied. A high CD8+-CTL count in ACC of surviving children is compelling evidence of an immune response against the disease. A better understanding of the options for enhancement of targets for CD8+ T cell recognition may provide insights for future pre-clinical studies.
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Affiliation(s)
- Ivy Zortéa S. Parise
- Pelé Pequeno Príncipe Research Institute, 1532 Silva Jardim, AV., Curitiba, PR 80250-200, Brazil
- Faculdades Pequeno Príncipe, 333 Iguaçu Av., Rebouças, Curitiba, PR 80230-902, Brazil
- Hospital Infantil Joana Gusmão, 152 Rui Barbosa St., Florianópolis, SC 88025-300, Brazil
| | - Guilherme A. Parise
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC), UFPR, 400 Agostinho Leão Jr. Av., Curitiba, PR 80030-110, Brazil
| | - Lúcia Noronha
- Serviço de Anatomia Patológica, Hospital de Clínicas, Universidade Federal do Paraná, 181 General Carneiro, Alto da Glória, Curitiba, PR 80060-900, Brazil
- Departamento de Medicina, PUCPR, 1155 Imaculada Conceição St., Prado Velho, Curitiba, PR 80215-901, Brazil
| | - Mirvat Surakhy
- Oxford Ludwig Institute for Cancer Research, Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus Research Build, Roosevelt Dr, Oxford OX3 7DQ, UK
| | - Thiago Demetrius Woiski
- Pelé Pequeno Príncipe Research Institute, 1532 Silva Jardim, AV., Curitiba, PR 80250-200, Brazil
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC), UFPR, 400 Agostinho Leão Jr. Av., Curitiba, PR 80030-110, Brazil
| | - Denise B. Silva
- Hospital Infantil Joana Gusmão, 152 Rui Barbosa St., Florianópolis, SC 88025-300, Brazil
| | - Tatiana EI-Jaick B. Costa
- Faculdades Pequeno Príncipe, 333 Iguaçu Av., Rebouças, Curitiba, PR 80230-902, Brazil
- Hospital Infantil Joana Gusmão, 152 Rui Barbosa St., Florianópolis, SC 88025-300, Brazil
| | | | - Heloisa Komechen
- Pelé Pequeno Príncipe Research Institute, 1532 Silva Jardim, AV., Curitiba, PR 80250-200, Brazil
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC), UFPR, 400 Agostinho Leão Jr. Av., Curitiba, PR 80030-110, Brazil
| | - Roberto Rosati
- Pelé Pequeno Príncipe Research Institute, 1532 Silva Jardim, AV., Curitiba, PR 80250-200, Brazil
- Faculdades Pequeno Príncipe, 333 Iguaçu Av., Rebouças, Curitiba, PR 80230-902, Brazil
| | - Melyssa Grignet Ribeiro
- Serviço de Anatomia Patológica, Hospital de Clínicas, Universidade Federal do Paraná, 181 General Carneiro, Alto da Glória, Curitiba, PR 80060-900, Brazil
| | | | - José Antônio de Souza
- Hospital Infantil Joana Gusmão, 152 Rui Barbosa St., Florianópolis, SC 88025-300, Brazil
| | - Diancarlos P. Andrade
- Pelé Pequeno Príncipe Research Institute, 1532 Silva Jardim, AV., Curitiba, PR 80250-200, Brazil
- Faculdades Pequeno Príncipe, 333 Iguaçu Av., Rebouças, Curitiba, PR 80230-902, Brazil
| | - Mariana M. Paraizo
- Pelé Pequeno Príncipe Research Institute, 1532 Silva Jardim, AV., Curitiba, PR 80250-200, Brazil
- Faculdades Pequeno Príncipe, 333 Iguaçu Av., Rebouças, Curitiba, PR 80230-902, Brazil
| | - Marjorana Martini R. Galvão
- Ciência Laboratório Médico Ltda-Hospital Infantil Joana de Gusmão, 152 Rui Barbosa St., Florianópolis, SC 88025-300, Brazil
| | - José Renato S. Barbosa
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC), UFPR, 400 Agostinho Leão Jr. Av., Curitiba, PR 80030-110, Brazil
| | - Miriam Lacerda Barbosa
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC), UFPR, 400 Agostinho Leão Jr. Av., Curitiba, PR 80030-110, Brazil
| | - Gislaine C. Custódio
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC), UFPR, 400 Agostinho Leão Jr. Av., Curitiba, PR 80030-110, Brazil
| | - Mirna M. O. Figueiredo
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC), UFPR, 400 Agostinho Leão Jr. Av., Curitiba, PR 80030-110, Brazil
| | - Ana Luiza M. R. Fabro
- Faculdades Pequeno Príncipe, 333 Iguaçu Av., Rebouças, Curitiba, PR 80230-902, Brazil
- Hospital Pequeno Príncipe, 1070 Desembargador Motta Av., Curitiba, Paraná 80250-060, Brazil
| | - Gareth Bond
- Oxford Ludwig Institute for Cancer Research, Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus Research Build, Roosevelt Dr, Oxford OX3 7DQ, UK
| | - Marco Volante
- Department of Oncology, University of Turin, San Luigi Hospital, regione Gonzole 10, Orbassano, 10043 Turin, Italy
| | - Enzo Lalli
- Institut de Pharmacologie Moléculaire et Cellulaire CNRS, 660 route des Lucioles, Sophia Antipolis, 06560 Valbonne, France
- Correspondence: (E.L.); (B.C.F.)
| | - Bonald C. Figueiredo
- Pelé Pequeno Príncipe Research Institute, 1532 Silva Jardim, AV., Curitiba, PR 80250-200, Brazil
- Faculdades Pequeno Príncipe, 333 Iguaçu Av., Rebouças, Curitiba, PR 80230-902, Brazil
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC), UFPR, 400 Agostinho Leão Jr. Av., Curitiba, PR 80030-110, Brazil
- Departamento de Saúde Coletiva, Federal University of Paraná, 280 Padre Camargo, Alto da Glória, Curitiba, PR 80060-240, Brazil
- Correspondence: (E.L.); (B.C.F.)
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Abstract
Adrenocortical carcinoma (ACC) is an aggressive and rare neoplasm that originates in the cortex of the adrenal gland. The disease is associated with heterogeneous but mostly poor outcomes and lacks effective pharmaceutical treatment options. Multi-omics studies have defined the landscape of molecular alterations in ACC. Specific molecular signatures can be detected in body fluids, potentially enabling improved diagnostic applications for patients with adrenal tumours. Importantly, pan-molecular data sets further reveal a spectrum within ACC, with three major subgroups that have different disease outcomes. These new subgroups have value as prognostic biomarkers. Research has revealed that the p53-RB and the WNT-β-catenin pathways are common disease drivers in ACC. However, these pathways remain difficult to target by therapeutic interventions. Instead, a unique characteristic of ACC is steroidogenic differentiation, which has emerged as a potential treatment target, with several agents undergoing preclinical or clinical investigations. Finally, a large proportion of ACC tumours have genetic profiles that are associated with promising therapeutic responsiveness in other cancers. All these opportunities now await translation from the laboratory into the clinical setting, thereby offering a real potential of improved survival outcomes and increased quality of life for patients with this serious condition.
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Affiliation(s)
- Joakim Crona
- Department of Medical Sciences, Uppsala Universitet, Uppsala, Sweden.
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany.
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zurich, Zurich, Switzerland.
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Balmant NV, de Souza Reis R, de Oliveira Santos M, de Camargo B, Gatta G. Rare cancers in childhood and adolescence in Brazil: First report of data from 19 population-based cancer registries. Cancer 2019; 125:2638-2646. [PMID: 31013367 DOI: 10.1002/cncr.32121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Rare childhood cancer is challenging to define. The Italian Pediatric Rare Tumor (TREP) Study considers rare tumors to include solid malignancies characterized by an annual incidence rate of <2 cases per 1 million and not enrolled in clinical trials. The objective of the current study was to analyze the population incidence rate of rare tumors among children and adolescents (those aged birth-19 years) in Brazil. METHODS Incidence data were obtained from 19 population-based cancer registries covering the 5 geographic regions in Brazil. Newly diagnosed cases were selected according to the TREP definition, using the International Classification of Diseases for Oncology. To calculate the crude incidence rate, the numbers of incident children and adolescents with a specific rare cancer were divided by the corresponding person-years lived for the population aged <20 years during the same period. RESULTS Two tumors had an incidence rate that was >2 cases per 1 million (thyroid and skin cancers) in adolescents only. Several tumors demonstrated variations in incidence across the Brazilian regions. Adrenocortical carcinoma had a high incidence rate (4 cases per 1 million) in the south region among children aged <10 years. Thyroid and skin carcinoma had higher incidence rates in the midwest, southeast, and south regions. CONCLUSIONS Due to the extraordinary rarity of these events, networking is important for improving basic research, clinical studies, and trials. Centralization of diagnosis is the only way to improve the diagnosis and treatment of children affected by these rare diseases. The registration and surveillance of rare pediatric cancers are crucial from a public health point of view, and therefore the quality of registration has to be improved.
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Affiliation(s)
- Nathalie V Balmant
- Postgraduate Program, Research Center, Hospital Cancer Foundation, Tumor registry, Rio de Janeiro, Brazil
| | | | | | - Beatriz de Camargo
- Postgraduate Program, Research Center, Hospital Cancer Foundation, Tumor registry, Rio de Janeiro, Brazil
| | - Gemma Gatta
- IRCCS Foundation, Evaluative Epidemiology Unit, Evaluative Epidemiology Unit, National Cancer Institute, Milan, Italy
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Smith SC, Warren LM, Cooley LD. Maintaining a methods database to optimize solid tumor tissue culture: Review of a 15-year database from a single institution. Cancer Genet 2019; 233-234:96-101. [DOI: 10.1016/j.cancergen.2019.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/28/2018] [Accepted: 01/30/2019] [Indexed: 12/20/2022]
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Monteiro NML, Rodrigues KEDS, Vidigal PVT, Oliveira BMD. CARCINOMA ADRENAL EM CRIANÇAS: ESTUDO LONGITUDINAL EM MINAS GERAIS, BRASIL. REVISTA PAULISTA DE PEDIATRIA 2019; 37:20-26. [PMID: 30066822 PMCID: PMC6362376 DOI: 10.1590/1984-0462/;2019;37;1;00002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 10/18/2017] [Indexed: 12/31/2022]
Abstract
Objective: To analyze clinical, laboratory and histopathological features and the path to diagnosis establishment and treatment of patients with adrenal carcinoma (AC). Methods: Retrospective study with 13 patients assisted at the pediatric oncology service of Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil, between 2004 and 2015. Results: Age at diagnosis ranged from 1.0 to 14.8 years (median: 2.0 years). Manifestations of hypercortisolism were identified in all cases and virilization in all girls. All patients met the Weiss criteria to AC histopathological diagnosis. Immunohistochemistry was performed in 61.5% of the cases. Most patients had stage I disease (76.9%). All subjects were submitted to total tumor resection. Two patients (stages III and IV disease) received chemotherapy associated to mitotane. The only death case was that of a patient with stage IV disease. The probability of overall survival for the entire group up to 5.0 years was 92.3±7.4%. The median time between the onset of symptoms and diagnosis was 9.5 months, and 6.0 months between first visit and start of treatment. Conclusions: Low age at diagnosis, predominance of cases with localized disease and complete tumor resection - with only one case of tumor capsule rupture - can possibly explain the favorable evolution of the studied population. The long period between onset of symptoms and diagnosis highlights the importance of training pediatricians for early recognition of AC signs and symptoms.
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Gupta N, Rivera M, Novotny P, Rodriguez V, Bancos I, Lteif A. Adrenocortical Carcinoma in Children: A Clinicopathological Analysis of 41 Patients at the Mayo Clinic from 1950 to 2017. Horm Res Paediatr 2018; 90:8-18. [PMID: 29804118 DOI: 10.1159/000488855] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Adrenocortical carcinoma (ACC) is an aggressive childhood cancer. Limited evidence exists on a definite histopathological criterion to differentiate ACC from adrenocortical adenoma. The aim of this study was to investigate the clinicopathological data of children with ACC, identify prognostic factors, and validate a histopathological criterion to differentiate ACC from adrenocortical adenoma. METHODS This retrospective cohort included 41 children, followed at the Mayo Clinic from 1950 to 2017 (onset of symptoms ≤21 years). Outcomes of interest were: alive with no evidence of disease, alive with evidence of disease, and dead of disease. RESULTS Median age at onset of symptoms was 15.7 years (n = 41; range, 0.2-21 years). Female:male ratio was 3.6: 1. Mixed symptomatology (> 1 hormone abnormality) was the most common presentation (54%, n = 22). Sixty-six percent of patients (n = 27 out of 41) underwent total adrenalectomy. Metastatic disease was more common in children aged > 12 years (p = 0.002 compared to < 4 years). The most common sites of metastases were the liver and lungs. Overall 2-year and 5-year survival rates were 61% (95% CI 45-77) and 46% (95% CI 30-62), respectively. Metastasis at the time of diagnosis was independently associated with poor prognosis (risk ratio 13.7%; 95% CI 3.9-87.7). Weiss criteria (29%) and modified Weiss criteria (33%) were less accurate in younger patients (< 12 years), compared to the Wieneke index (100%). CONCLUSION The presence of metastases was an independent prognostic factor. The Wieneke index was the most accurate in predicting clinical outcomes in younger children.
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Affiliation(s)
- Nidhi Gupta
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Rivera
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul Novotny
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Vilmarie Rodriguez
- Division of Pediatric Hematology-Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Aida Lteif
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
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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.
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Affiliation(s)
- Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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