Adrenal cancer: relevance of different grading systems and subtypes

Clinical & Translational Oncology ◽

10.1007/s12094-020-02524-2 ◽

2021 ◽

Author(s):

S. Minner ◽

J. Schreiner ◽

W. Saeger

Keyword(s):

Scoring Systems ◽

Soft Tissue Tumors ◽

Ki 67 ◽

Score System ◽

Routine Work ◽

Grading Systems ◽

Special Cases ◽

Ordinary Type ◽

Criteria For Diagnosis

Abstract Purpose The subclassification of adrenal cancers according to the WHO classification in ordinary, myxoid, oncocytic, and sarcomatoid as well as pediatric types is well established, but the criteria for each subtype are not sufficiently determined and the relative frequency of the different types of adrenal cancers has not been studied in large cohorts. Therefore, our large collection of surgically removed adrenal cancers should be reviewed o establish the criteria for the subtypes and to find out the frequency of the various types. Methods In our series of 521 adrenal cancers the scoring systems of Weiss et al., Hough et al., van Slooten et al. and the new Helsinki score system were used for the ordinary type of cancer (97% of our series) and the myxoid type (0.8%). For oncocytic carcinomas (2%), the scoring system of Bisceglia et al. was applied. Results Discrepancies between benign and malignant diagnoses from the first thee classical scoring systems are not rare (22% in our series) and could be resolved by the Helsinki score especially by Ki-67 index (more than 8% unequivocally malignant). Since all our cancer cases are positive in the Helsinki score, this system can replace the three elder systems. For identification of sarcomatoid cancer as rarest type in our series (0.2%), the scoring systems are not practical but additional immunostainings used for soft tissue tumors and in special cases molecular pathology are necessary to differentiate these cancers from adrenal sarcomas. According to the relative frequencies of the different subtypes of adrenal cancers the main type is the far most frequent (97%) followed by the oncocytic type (2%), the myxoid type (0.8%) and the very rare sarcomatoid type (0.2%). Conclusions The Helsinki score is the best for differentiating adrenal carcinomas of the main, the oncocytic, and the myxoid type in routine work. Additional scoring systems for these carcinomas are generally not any longer necessary. Signs of proliferation (mitoses and Ki-67 index) and necroses are the most important criteria for diagnosis of malignancy.

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How to better predict weight loss and type 2 diabetes remission after bariatric surgery? the potential role of genetic scoring systems in clinical practice

Endocrine Abstracts ◽

10.1530/endoabs.56.gp153 ◽

2018 ◽

Author(s):

Albert Lecube ◽

Rafael Simo ◽

Andreea Ciudin ◽

Sara Pich ◽

Nuria Vilarrasa ◽

...

Keyword(s):

Type 2 Diabetes ◽

Bariatric Surgery ◽

Weight Loss ◽

Potential Role ◽

Scoring Systems ◽

Diabetes Remission ◽

Predict Weight Loss ◽

Type 2 Diabetes Remission

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Calcitonin-Negative Neuroendocrine Carcinoma of the Thyroid Gland: Case Report and Literature Review

Case Reports in Oncology ◽

10.1159/000510807 ◽

2021 ◽

pp. 112-122

Author(s):

Ricardo Fernández-Ferreira ◽

Ildefonso Roberto De la Peña-López ◽

Karla Walkiria Zamudio-Coronado ◽

Luis Antonio Delgado-Soler ◽

María Eugenia Torres-Pérez ◽

...

Keyword(s):

Thyroid Carcinoma ◽

English Language ◽

Neoadjuvant Treatment ◽

Complete Response ◽

Cervical Region ◽

Proliferation Index ◽

Ki 67 ◽

Definitive Evidence ◽

Criteria For Diagnosis ◽

Fdg Pet Ct

Calcitonin-negative neuroendocrine tumor (CNNET) of the thyroid is an extremely rare entity. In some of the previously reported cases within the literature, the terms “atypical medullary thyroid carcinoma,” “calcitonin-free oat cell carcinoma,” and “a distinct clinical entity” were applied to NETs without definitive evidence of calcitonin production. In the English-language literature, not only are there only few reported cases of CNNET, but the criteria for diagnosis in these cases are also controversial. Most of the current published cases were also treated surgically for local disease. We describe a case of NET of the thyroid with calcitonin, chromogranin A and thyroglobulin negativity, synaptophysin and TTF-1 positivity, and a high Ki-67 proliferation index with metastases in the cervical region as well as mediastinal adenopathies. This case was considered an unresectable thyroid carcinoma, and chemotherapy including cisplatin and etoposide was started as neoadjuvant treatment at the department of medical oncology. Total thyroidectomy plus bilateral and central cervical dissection was performed, and the patient underwent 2 cycles of adjuvant radiotherapy. Currently, the patient’s 18F-FDG-PET/CT findings show a complete response 17 months after diagnosis. In conclusion, CNNET of the thyroid is very rare and there is limited evidence regarding treatment in patients with metastases. Chemotherapy including cisplatin and etoposide as well as early aggressive surgical resection appears to positively impact patients’ survival.

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Numbers of host "helper" T cells and proliferating cells predict survival in diffuse small-cell lymphomas.

Journal of Clinical Oncology ◽

10.1200/jco.1989.7.8.1009 ◽

1989 ◽

Vol 7 (8) ◽

pp. 1009-1017 ◽

Cited By ~ 29

Author(s):

L J Medeiros ◽

L J Picker ◽

A B Gelb ◽

J G Strickler ◽

S W Brain ◽

...

Keyword(s):

Patient Survival ◽

T Antigen ◽

Small Cell ◽

Proliferating Cells ◽

Actuarial Survival ◽

Ki 67 ◽

Lymphoid Malignancies ◽

Routine Work ◽

B Lineage ◽

Work Up

Diffuse small-cell lymphomas of B-lineage comprise a group of immunophenotypically related lymphoid malignancies that display variable clinical aggressiveness. We compared a variety of clinical, pathologic, and immunologic characteristics of 64 B-lineage diffuse small-cell lymphomas to patient survival in an effort to define prognostically relevant subtypes of these neoplasms. Neither clinical parameters nor histological subclassification correlated with patient outcome. In contrast, three immunologic features of these lymphomas showed a statistically significant relationship with actuarial survival. Neoplasms that manifested greater than or equal to 25% Ki-67+ cells (proliferation-associated antigen), less than 25% Leu 4+ cells (pan-T antigen), or less than 15% Leu 3+ cells (helper/inducer T-subset antigen) were associated with significantly decreased patient survival as compared to neoplasms with the reverse phenotype (P = .02, P = .003, P = .0005, respectively). Leu 3 findings were of particular importance in initial biopsies (P = .0007), while the Ki-67 findings were significant regardless of time of biopsy (P = .01 for biopsies at diagnosis and P = .004 for other biopsies). These data indicate that immunologic analysis can demonstrate subsets of diffuse small-cell lymphoma with different biologic potential, and suggest that such analysis be included in the routine work-up of patients with this type of neoplasm.

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Ki-67 is a predictor of acromegaly control with octreotide LAR independent of SSTR2 status and relates to cytokeratin pattern

Acta Endocrinologica ◽

10.1530/eje-13-0349 ◽

2013 ◽

Vol 169 (2) ◽

pp. 217-223 ◽

Cited By ~ 28

Author(s):

Leandro Kasuki ◽

Luiz Eduardo Armondi Wildemberg ◽

Leonardo Vieira Neto ◽

Jorge Marcondes ◽

Christina M Takiya ◽

...

Keyword(s):

Multivariate Analysis ◽

Protein Expression ◽

Expression Patterns ◽

Somatostatin Receptor ◽

Labeling Index ◽

Cell Nuclei ◽

Ki 67 ◽

Octreotide Lar ◽

Cytokeratin Expression

IntroductionOnly one study has evaluated Ki-67 as a predictor of the response to somatostatin analog therapy in acromegaly; however, other predictors like somatostatin receptor type 2 (SSTR2) and cytokeratin pattern expressions were not considered.ObjectiveTo evaluate whether Ki-67 is a predictor of octreotide LAR (OCT-LAR) response in somatotropinomas independent of SSTR2 and cytokeratin expression patterns.MethodsProtein expression was analyzed by immunohistochemistry. The percentage of cell nuclei that were immunolabeled for Ki-67 and the percentage of cells with positive SSTR2 staining were calculated. SSTR2 expression was considered high when ≥25%, and a cutoff of 2.3% was designated for Ki-67. Tumors were classified as densely or sparsely granulated according to the cytokeratin pattern.ResultsThirty-one somatotropinomas were studied. Fourteen patients (45.2%) were controlled with OCT-LAR therapy. The median Ki-67 labeling index (LI) was higher in patients not controlled with OCT-LAR than in those controlled (1.63 and 0.15 respectively, P=0.002). Higher SSTR2 expression and densely granulated tumors were correlated with control as well (P=0.04 and 0.038 respectively). There was no difference in Ki-67 levels between patients with high and low SSTR2 expression (P=0.651). After multivariate analysis, both Ki-67 and SSTR2 remained statistically significant as predictors of OCT-LAR response (P=0.017 and 0.012 respectively). The Ki-67 LI was higher in sparsely than in densely granulated tumors (P=0.047).ConclusionsKi-67 is a predictor of response to OCT-LAR in acromegaly, independent of SSTR2 expression and relates to cytokeratin patterns.

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Topoisomerase II alpha expression and the Ki-67 labeling index correlate with prognostic factors in estrogen receptor-positive and human epidermal growth factor type-2-negative breast cancer

Breast Cancer ◽

10.1007/s12282-011-0291-4 ◽

2011 ◽

Vol 19 (4) ◽

pp. 309-314 ◽

Cited By ~ 13

Author(s):

Hideaki Tokiniwa ◽

Jun Horiguchi ◽

Daisuke Takata ◽

Mami Kikuchi ◽

Nana Rokutanda ◽

...

Keyword(s):

Breast Cancer ◽

Estrogen Receptor ◽

Prognostic Factors ◽

Topoisomerase Ii ◽

Topoisomerase Ii Alpha ◽

Ki 67 ◽

Estrogen Receptor Positive ◽

Epidermal Growth ◽

Factor Type

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The effect of chronic renal failure on critical illness

10.1093/med/9780199600830.003.0218 ◽

2016 ◽

Author(s):

Sinead Kinsella ◽

John Holian

Keyword(s):

Critical Illness ◽

Kidney Disease ◽

Renal Disease ◽

Kidney Injury ◽

Scoring Systems ◽

Disease Status ◽

Icu Admission ◽

Critical Care Management ◽

End Stage

The incidence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) is increasing, reflecting an increase in the incidence and prevalence of hypertension and type 2 diabetes. Patients with CKD and ESKD frequently experience episodes of critical illness and require treatment in an intensive care unit (ICU)setting. Management requires specific consideration of their renal disease status together with their acute illness. Mortality in critically-ill patients with ESKD is frequently related to their co-morbid conditions, rather than their ESKD status. Illness severity scoring systems allocate high points for renal variables and tend to overestimate actual mortality. Patients with ESKD and CKD requiring ICU admission have better ICU and in-hospital survival than patients with denovo acute kidney injury requiring renal replacement therapy. Appropriately selected patients benefit from ICU admission and full consideration for ICU care should be given to these patients if required, despite their renal disease status. Cardiovascular disease and sepsis account for the majority of ICU admissions in this population and the aetiology of these conditions differs from that in patients without kidney disease. Optimal critical care management of patients with ESKD and CKD requires that these differences are recognized.

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Predicting Metastatic Potential in Pheochromocytoma and Paraganglioma: A Comparison of PASS and GAPP Scoring Systems

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa608 ◽

2020 ◽

Vol 105 (12) ◽

pp. e4661-e4670

Author(s):

Heather Wachtel ◽

Troy Hutchens ◽

Ezra Baraban ◽

Lauren E Schwartz ◽

Kathleen Montone ◽

...

Keyword(s):

Proportional Hazards ◽

Cox Regression ◽

Intraclass Correlation ◽

Scoring Systems ◽

Metastatic Potential ◽

Disease Recurrence ◽

Cox Proportional Hazards ◽

Ki 67 ◽

Kaplan Meier ◽

Adrenal Pheochromocytoma

Abstract Purpose The Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) and the Grading System for Adrenal Pheochromocytoma and Paraganglioma (GAPP) are scoring systems to predict metastatic potential in pheochromocytomas (PCC) and paragangliomas (PGLs). The goal of this study is to assess PASS and GAPP as metastatic predictors and to correlate with survival outcomes. Methods The cohort included PCC/PGL with ≥5 years of follow-up or known metastases. Surgical pathology slides were rereviewed. PASS and GAPP scores were assigned. Univariable and multivariable logistic regression, Kaplan–Meier survival analysis, and Cox proportional hazards were performed to assess recurrence-free survival (RFS) and disease-specific survival (DSS). Results From 143 subjects, 106 tumors were PCC and 37 were PGL. Metastases developed in 24%. The median PASS score was 6.5 (interquartile range [IQR]: 4.0-8.0) and median GAPP score was 3.0 (IQR: 2.0-4.0). Interrater reliability was low–moderate for PASS (intraclass correlation coefficient [ICC]: 0.6082) and good for GAPP (ICC 0.7921). Older age (OR: 0.969, P = .0170) was associated with longer RFS. SDHB germline pathogenic variant (OR: 8.205, P = .0049), extra-adrenal tumor (OR: 6.357, P < .0001), Ki-67 index 1% to 3% (OR: 4.810, P = .0477), and higher GAPP score (OR: 1.537, P = .0047) were associated with shorter RFS. PASS score was not associated with RFS (P = .1779). On Cox regression, a GAPP score in the moderately differentiated range was significantly associated with disease recurrence (HR: 3.367, P = .0184) compared with well-differentiated score. Conclusion Higher GAPP scores were associated with aggressive PCC/PGL. PASS score was not associated with metastases and demonstrated significant interobserver variability. Scoring systems for predicting metastatic PCC/PGL may be improved by incorporation of histopathology, clinical data, and germline and somatic tumor markers.

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Abstract WMP78: Investigating the Utility of Previously Developed Prediction Scores in AIS patients in the Stroke Belt

Stroke ◽

10.1161/str.44.suppl_1.awmp78 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Pawan V Rawal ◽

Amelia K Boehme ◽

Reza Bavarsad Shahripour ◽

Paola Palazzo ◽

Karen C Albright ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Scoring Systems ◽

Roc Curves ◽

Stroke Patients ◽

Symptomatic Intracerebral Hemorrhage ◽

Baseline Characteristics ◽

Stroke Belt ◽

Iv Tpa

Background: A number of scoring systems have been developed in different geographic and treatment populations, however, it remains unknown how these scores perform in the Stroke Belt population. We sought to validate and assess the utility of the SEDAN, THRIVE, HIAT and HIAT2 scoring systems among patients receiving systemic (IV tPA) and endovascular (IAT) reperfusion. Methods: We retrospectively reviewed all IV tPA and IAT patients presenting to our tertiary care center from 2009-2011. The scores were assessed in IV tPA only patients, IAT only patients and in patients who received both therapies (IV-IA). We tested THRIVE for predicting mRS 3-6, HIAT and HIAT2 for mRS 4-6, and SEDAN for symptomatic intracerebral hemorrhage (sICH). sICH was defined as a Type 2 parenchymal hemorrhage with deterioration in NIHSS score of 4 points or death. ROC curves were used to evaluate each score within the three groups. Result: Of the 366 patients who were included in this study, 89 had IAT only, 243 had IV tPA only and 34 had IV-IA. Figure 1a shows their demographic and baseline characteristics. Figure 1b shows the performance of SEDAN, THRIVE, HIAT and HIAT2 scores in our population (ROC range from 0.512-0.818). Conclusion: The two scores developed in the Stroke Belt, HIAT and HIAT2, performed well in the patient group for which they were developed (IAT). Additionally, they are also good predictors in other groups (IV and IV-IA). THRIVE performed well for predicting mRS 3-6 in all three groups. SEDAN was only moderately useful in predicting sICH after IV tPA. SEDAN had poor predictive value in IAT and IV-IA. These results highlight the need for validating clinical scores in different patient populations to determine their generalizability to all stroke patients.

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