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Myxoid and Sarcomatoid Variants of Adrenocortical Carcinoma: Analysis of Rare Variants in Single Tertiary Care Center

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ABSTRACT

The aim of this study is to describe rare variants of adrenocortical carcinoma (ACC) and to compare the prognosis with that of conventional ACC. We retrospectively reviewed 8 cases of myxoid variant, 1 sarcomatoid variant, and 14 cases of conventional ACC, who underwent surgical resection at the Asan Medical Center between 1996 and 2014. An analysis of the clinicopathological characteristics, including the Weiss score, Ki-67 labeling index, and reticulin framework assessment is presented. The mean age of patients with myxoid/sarcomatoid ACC was 45 years; 4 out of 9 patients were women. Mean primary tumor size was 12.9 cm and the mean weight was 702.4 g. Seven patients presented in an advanced stage (stage III/IV); 8 of these eventually developed distant metastasis. The mean Weiss score was 5.0 points and the Ki-67 labeling index was 15.6%. The extent of myxoid or sarcomatoid change on histological examination ranged from 10% to 75% of the examined tumor areas; reticulin framework alteration was observed in all cases. Four patients showed venous tumor thrombus. Most of the clinicopathological parameters were not significantly different from those of conventional ACC. However, myxoid or sarcomatoid variant (hazard ratios [HR], 3.59; 95% confidence intervals [CI], 1.13–11.38; P = 0.030) and Ki-67 labeling index (HR, 3.97; 95% CI, 1.18–13.41; P = 0.030) were independent predictors of overall survival after adjusting for age and sex. Myxoid or sarcomatoid histological features or an increased Ki-67 labeling index may be associated with poor overall survival in patients with ACC.

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Histological features of myxoid (A-D) and sarcomatoid (E, F) variants of ACC. Grossly, the myxoid variant ACC shows a variegated cut surface with yellowish tan, necrotic, focally gelatinous and hemorrhagic foci (A). Tumor cells of myxoid ACC show various growth patterns, including inter-anastomosing cords, small clusters, and microcystic patterns (B) in an Alcian-Blue positive myxoid stroma background (C) and also show reticulin network alterations (D). Grossly, the sarcomatoid variant of ACC shows a variegated cut surface with yellowish tan, necrotic, and partially white fleshy foci (E). Tumor cells of the sarcomatoid variant ACC show a diffuse growth pattern with mainly spindle cells (F).ACC = adrenocortical carcinoma.
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Figure 1: Histological features of myxoid (A-D) and sarcomatoid (E, F) variants of ACC. Grossly, the myxoid variant ACC shows a variegated cut surface with yellowish tan, necrotic, focally gelatinous and hemorrhagic foci (A). Tumor cells of myxoid ACC show various growth patterns, including inter-anastomosing cords, small clusters, and microcystic patterns (B) in an Alcian-Blue positive myxoid stroma background (C) and also show reticulin network alterations (D). Grossly, the sarcomatoid variant of ACC shows a variegated cut surface with yellowish tan, necrotic, and partially white fleshy foci (E). Tumor cells of the sarcomatoid variant ACC show a diffuse growth pattern with mainly spindle cells (F).ACC = adrenocortical carcinoma.

Mentions: Grossly, the myxoid or sarcomatoid variant ACCs examined in our current study were variably encapsulated masses with lobulation, focally gelatinous and with translucent cut surfaces (myxoid variant, Fig. 1A), or yellow-tanned and partially white fleshy cut surface (sarcomatoid variant, Fig. 1E). These tumors ranged in size from 3.8 to 22.0 cm in their greatest dimension and weighed between 38.5 and 2,292.0 g. These showed immunopositivity for inhibin, synaptophysin, melan-A, and immunonegativity for chromogranin at the time of initial diagnosis, which is supportive of the diagnosis of ACC. Microscopically, the extent of myxoid or sarcomatoid change ranged from approximately 10%–75% in the 8 cases of myxoid ACC and 60% in the lone case of sarcomatoid ACC. The myxoid areas showed various growth patterns, including trabecular, inter-anastomosing cords, small clusters and microcystic patterns in a loose myxoid stromal component background (Fig. 1B). Tumor cells in the myxoid areas were relatively smaller than those in the non-myxoid areas and showed mild nuclear atypia, hyperchromatic nuclei, inconspicuous nucleoli, and scant eosinophilic cytoplasm.


Myxoid and Sarcomatoid Variants of Adrenocortical Carcinoma: Analysis of Rare Variants in Single Tertiary Care Center
Histological features of myxoid (A-D) and sarcomatoid (E, F) variants of ACC. Grossly, the myxoid variant ACC shows a variegated cut surface with yellowish tan, necrotic, focally gelatinous and hemorrhagic foci (A). Tumor cells of myxoid ACC show various growth patterns, including inter-anastomosing cords, small clusters, and microcystic patterns (B) in an Alcian-Blue positive myxoid stroma background (C) and also show reticulin network alterations (D). Grossly, the sarcomatoid variant of ACC shows a variegated cut surface with yellowish tan, necrotic, and partially white fleshy foci (E). Tumor cells of the sarcomatoid variant ACC show a diffuse growth pattern with mainly spindle cells (F).ACC = adrenocortical carcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5383608&req=5

Figure 1: Histological features of myxoid (A-D) and sarcomatoid (E, F) variants of ACC. Grossly, the myxoid variant ACC shows a variegated cut surface with yellowish tan, necrotic, focally gelatinous and hemorrhagic foci (A). Tumor cells of myxoid ACC show various growth patterns, including inter-anastomosing cords, small clusters, and microcystic patterns (B) in an Alcian-Blue positive myxoid stroma background (C) and also show reticulin network alterations (D). Grossly, the sarcomatoid variant of ACC shows a variegated cut surface with yellowish tan, necrotic, and partially white fleshy foci (E). Tumor cells of the sarcomatoid variant ACC show a diffuse growth pattern with mainly spindle cells (F).ACC = adrenocortical carcinoma.
Mentions: Grossly, the myxoid or sarcomatoid variant ACCs examined in our current study were variably encapsulated masses with lobulation, focally gelatinous and with translucent cut surfaces (myxoid variant, Fig. 1A), or yellow-tanned and partially white fleshy cut surface (sarcomatoid variant, Fig. 1E). These tumors ranged in size from 3.8 to 22.0 cm in their greatest dimension and weighed between 38.5 and 2,292.0 g. These showed immunopositivity for inhibin, synaptophysin, melan-A, and immunonegativity for chromogranin at the time of initial diagnosis, which is supportive of the diagnosis of ACC. Microscopically, the extent of myxoid or sarcomatoid change ranged from approximately 10%–75% in the 8 cases of myxoid ACC and 60% in the lone case of sarcomatoid ACC. The myxoid areas showed various growth patterns, including trabecular, inter-anastomosing cords, small clusters and microcystic patterns in a loose myxoid stromal component background (Fig. 1B). Tumor cells in the myxoid areas were relatively smaller than those in the non-myxoid areas and showed mild nuclear atypia, hyperchromatic nuclei, inconspicuous nucleoli, and scant eosinophilic cytoplasm.

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this study is to describe rare variants of adrenocortical carcinoma (ACC) and to compare the prognosis with that of conventional ACC. We retrospectively reviewed 8 cases of myxoid variant, 1 sarcomatoid variant, and 14 cases of conventional ACC, who underwent surgical resection at the Asan Medical Center between 1996 and 2014. An analysis of the clinicopathological characteristics, including the Weiss score, Ki-67 labeling index, and reticulin framework assessment is presented. The mean age of patients with myxoid/sarcomatoid ACC was 45 years; 4 out of 9 patients were women. Mean primary tumor size was 12.9 cm and the mean weight was 702.4 g. Seven patients presented in an advanced stage (stage III/IV); 8 of these eventually developed distant metastasis. The mean Weiss score was 5.0 points and the Ki-67 labeling index was 15.6%. The extent of myxoid or sarcomatoid change on histological examination ranged from 10% to 75% of the examined tumor areas; reticulin framework alteration was observed in all cases. Four patients showed venous tumor thrombus. Most of the clinicopathological parameters were not significantly different from those of conventional ACC. However, myxoid or sarcomatoid variant (hazard ratios [HR], 3.59; 95% confidence intervals [CI], 1.13–11.38; P = 0.030) and Ki-67 labeling index (HR, 3.97; 95% CI, 1.18–13.41; P = 0.030) were independent predictors of overall survival after adjusting for age and sex. Myxoid or sarcomatoid histological features or an increased Ki-67 labeling index may be associated with poor overall survival in patients with ACC.

No MeSH data available.


Related in: MedlinePlus