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Radiologically defined lipid-poor adrenal adenomas: histopathological characteristics

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Abstract

Background

Adrenal lipid-poor adenomas (LPA) are defined by high unenhanced density (≥ 10 HU), and absolute and relative contrast medium washout > 60% and > 40%, respectively, at computerized tomography (CT). To date, no thorough histopathological characterization has been performed in those frequent lesions (one-third of adrenal adenomas). Our aim was to analyze the histopathological characteristics of adrenal LPA.

Methods

Patients with LPA (n = 57) were selected among consecutive subjects referred for an adrenal incidentaloma or ACTH-independent Cushing syndrome. FluoroDeoxyGlucose-Positron Emission Tomography (FDG-PET) was performed in 37 patients. In patients treated by adrenalectomy (n = 17), Weiss score and Lin–Weiss–Bisceglia score (in tumors composed entirely or predominantly of oncocytes) were calculated.

Results

Radiological parameters did not differ among patients with ACTH-independent Cushing syndrome (n = 6) and those with adrenal incidentalomas associated with primary aldosteronism (n = 2), autonomous cortisol secretion (n = 14), or non-functioning (n = 35). Patients treated by adrenalectomy had larger tumors (28.9 ± 11.2 vs 17.3 ± 8.4 mm, P < 0.001), higher CT unenhanced density (29.1 ± 11.0 vs 23.1 ± 9.0 HU, P = 0.043), and FDG-PET adrenal uptake (9.0 ± 6.4 vs 4.4 ± 2.3 SUV, P = 0.003) than non-operated ones. Oncocytic features > 75% of the tumor were detected in 12/17 cases (70.6%). Five of those showed borderline-malignant histopathological characteristics by Lin–Weiss–Bisceglia score. Among remaining non-oncocytic tumors, 1/5 had a Weiss score ≥ 3. Overall, 6/17 tumors (35.3%) had borderline-malignant potential. Radiological parameters were similar between patients with benign and borderline-malignant tumors.

Conclusions

Adrenal LPA are a heterogeneous group of tumors, mostly composed of oncocytomas. Up to 1/3 of those tumors may have a borderline-malignant potential at histopathology.

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References

  1. Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, Tabarin A, Terzolo M, Tsagarakis S, Dekkers OM (2016) Management of adrenal incidentalomas: european society of endocrinology clinical practice guideline in collaboration with the european network for the study of adrenal tumors. Eur J Endocrinol 175:G1–G34

    Article  CAS  Google Scholar 

  2. Dinnes J, Bancos I, Di Ruffano LF, Chortis V, Davenport C, Bayliss S, Sahdev A, Guest P, Fassnacht M, Deeks JJ, Arlt W (2016) Management of endocrine disease: Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis. Eur J Endocrinol 175:R51–R64

    Article  CAS  Google Scholar 

  3. Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, Brink JA, Baker ME, Federle MP, Foley WD et al (2010) Managing incidental findings on abdominal CT: white paper of the ACR Incidental Findings Committee. J Am Coll Radiol 7:754–773

    Article  Google Scholar 

  4. Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, Naruse M, Pacak K, Young WF (2014) Endocrine society. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metabol 99:1915–1942

    Article  CAS  Google Scholar 

  5. Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, Montori VM (2008) The diagnosis of Cushing’s syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 93:1526–1540

    Article  CAS  Google Scholar 

  6. Di Dalmazi G, Fanelli F, Mezzullo M, Casadio E, Rinaldi E, Garelli S, Giampalma E, Mosconi C, Golfieri R, Vicennati V et al (2015) Steroid profiling by LC-MS/MS in nonsecreting and subclinical cortisol-secreting adrenocortical adenomas. J Clin Endocrinol Metab 100:3529–3538

    Article  Google Scholar 

  7. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF (2016) The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 101:1889–1916

    Article  CAS  Google Scholar 

  8. Weiss LM (1984) Comparative histologic study of 43 metastasizing and nonmetastasizing adrenocortical tumors. Am J Surg Pathol 8:163–169

    Article  CAS  Google Scholar 

  9. Bisceglia M, Ludovico O, Di Mattia A, Ben-Dor D, Sandbank J, Pasquinelli G, Lau SK, Weiss LM (2004) Adrenocortical oncocytic tumors: report of 10 cases and review of the literature. Int J Surg Pathol 12:231–243

    Article  Google Scholar 

  10. Volante M, Bollito E, Sperone P et al (2009) Clinicopathological study of a series of 92 adrenocortical carcinomas: from a proposal of simplified diagnostic algorithm to prognostic stratification. Histopathology 55:535–543

    Article  Google Scholar 

  11. Duregon E, Volante M, Cappia S, Cuccurullo A, Bisceglia M, Wong DD, Spagnolo DV, Szpak-Ulczok S, Bollito E, Daffara F, Berruti A, Terzolo M, Papotti M (2011) Oncocytic adrenocortical tumors: diagnostic algorithm and mitochondrial DNA profile in 27 cases. Am J Surg Pathol 35(12):1882–1893. https://doi.org/10.1097/PAS.0b013e31822da401

    Article  PubMed  Google Scholar 

  12. Peña CS, Boland GW, Hahn PF, Lee MJ, Mueller PR (2000) Characterization of indeterminate (lipid-poor) adrenal masses: use of washout characteristics at contrast-enhanced CT. Radiology 217:798–802

    Article  Google Scholar 

  13. Papotti M, Libè R, Duregon E, Volante M, Bertherat J, Tissier F (2011) The Weiss score and beyond–histopathology for adrenocortical carcinoma. Horm Cancer 2:333–340

    Article  CAS  Google Scholar 

  14. Wong DD, Spagnolo DV, Bisceglia M, Havlat M, McCallum D, Platten MA (2011) Oncocytic adrenocortical neoplasms—a clinicopathologic study of 13 new cases emphasizing the importance of their recognition. Hum Pathol 42:489–499

    Article  CAS  Google Scholar 

  15. Pennanen M, Raade M, Louhimo J, Sane T, Heiskanen I, Arola J, Haglund C (2013) Adrenocortical tumours: high CT attenuation value correlates with eosinophilia but does not discriminate lipid-poor adenomas from malignancy. J Clin Pathol 66:1076–1080

    Article  Google Scholar 

  16. Chambre C, McMurray E, Baudry C, Lataud M, Guignat L, Gaujoux S, Lahlou N, Guibourdenche J, Tissier F, Sibony M et al (2015) The 10 Hounsfield units unenhanced computed tomography attenuation threshold does not apply to cortisol secreting adrenocortical adenomas. Eur J Endocrinol 173:325–332

    Article  CAS  Google Scholar 

  17. Kebapci M, Kaya T, Gurbuz E, Adapinar B, Kebapci N, Demirustu C (2003) Differentiation of adrenal adenomas (lipid rich and lipid poor) from nonadenomas by use of washout characteristics on delayed enhanced CT. Abdom Imag 28:709–715

    Article  CAS  Google Scholar 

  18. Wang X, Li K, Sun H, Zhao J, Zheng L, Zhang Z, Bai R, Zhang G (2016) Differentiation between adrenal adenomas and nonadenomas using dynamic contrast-enhanced computed tomography. OncoTargets Ther 9:6809–6817

    Article  Google Scholar 

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Acknowledgements

The Multidisciplinary Adrenal Team-Bologna (MAT-BO) includes the following medical specialists: VV, UP, GDiD, GZ, BB (Division of Endocrinology, Department of Medical and Surgical Sciences, University of Bologna), CM, CB, RG (Division of Radiology, S. Orsola-Malpighi Hospital, Bologna), ERC, CB (Hypertension Unit, Department of Medical and Surgical Sciences, University of Bologna), CN (Metropolitan Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna), SS, FM (General Surgery, Department of Medical and Surgical Sciences, University of Bologna), ADeL, DS (Pathology Unit, University of Bologna), MAP, MS, MN (Department of Experimental, Diagnostic and Specialty Medicine, Sant’Orsola-Malpighi Hospital, and “G. Prodi” Interdepartmental Center for Cancer Research, University of Bologna).

Funding

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

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Author notes

  1. A. De Leo, C. Mosconi have contributed equally to the work.

Authors and Affiliations

  1. Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

    A. De Leo, C. Ceccarelli & D. Santini

  2. Radiology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy

    C. Mosconi, C. Balacchi & R. Golfieri

  3. Endocrinology Unit, Department of Medical and Surgical Sciences, University of Bologna, Malpighi Hospital, Alma Mater Studiorum University of Bologna, S. Orsola Policlinic, via Massarenti 9, 40138, Bologna, Italy

    G. Zavatta, L. Tucci, U. Pagotto, V. Vicennati & G. Di Dalmazi

  4. Metropolitan Nuclear Medicine, S. Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy

    C. Nanni & S. Fanti

  5. General Surgery, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

    S. Selva & F. Minni

  6. Department of Experimental, Diagnostic and Specialty Medicine, Oncology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    M. A. Pantaleo

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  1. A. De Leo
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  2. C. Mosconi
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Correspondence to G. Di Dalmazi.

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The study was approved by the local ethics committee of the S. Orsola-Malpighi Hospital (CE-AVEC).

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De Leo, A., Mosconi, C., Zavatta, G. et al. Radiologically defined lipid-poor adrenal adenomas: histopathological characteristics. J Endocrinol Invest 43, 1197–1204 (2020). https://doi.org/10.1007/s40618-020-01198-5

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  • DOI: https://doi.org/10.1007/s40618-020-01198-5

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