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Research Letter
September 8, 2021

Evaluation of Necrosis as a Diagnostic and Prognostic Indicator in Adrenocortical Carcinoma

Author Affiliations
  • 1Department of Surgery, University of California, San Francisco
  • 2Inova Schar Cancer Institute, Fairfax, Virginia
  • 3Department of Surgery, University of California, Davis
  • 4Department of Pathology, University of California, San Francisco
  • 5Section of Endocrine Surgery, Department of Surgery, University of California, San Francisco
JAMA Surg. Published online September 8, 2021. doi:10.1001/jamasurg.2021.3646

Adrenocortical carcinoma (ACC) is rare and has a poor prognosis. In part because of its rarity, the pathological diagnosis of ACC is based on unstandardized criteria that are difficult to apply. Histologic variants further complicate the differentiation of benign and malignant disease in the adrenal gland.1 Scoring systems and algorithms for the pathological diagnosis of ACC have been proposed. For example, the widely used Weiss scoring system evaluates 9 histologic parameters, but it is difficult for nonexpert pathologists to apply, is not reproducible for morphologic variants, is not universally recognized or reported, and fails to predict adverse outcomes for patients with low-grade disease.2,3 Attempts to simplify the Weiss scoring system include the modified Weiss criteria and the Helsinki score.4 In 2020, Walz et al5 proposed a simplified system to evaluate necrosis exclusively and differentiate benign from malignant adrenocortical neoplasms (ACNs). We used our adrenal tissue biorepository to evaluate this system’s potential and review the presence of necrosis in ACC as a diagnostic and prognostic indicator.

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