Adrenocortical Carcinoma

Question 1

MC metastatic lesions to adrenal?

Answer 1

1. melanoma
2. breast
3. lung cancer
4. renal

Question 2

Lymph node mets of primary adrenocortical carcinoma?

Answer 2

usually para-aortic, peri-aortic, retroperitoneal

Question 3

What is the Weiss criteria used for?

Answer 3

9 pathologic criteria that differentiates adenoma vs adrenocortical carcinoma

Question 4

What are the Weiss criteria?

Answer 4

1. Fuhrman grade 3-4
2. Mitotic rate > 5/hpf
3. Atypical mitotic features
4. <25% cytoplasm in cells
5. > 1/3 diffuse growth pattern
6. Necrosis
7. Venous invasion
8. Sinusoid invasion
9. Tumor capsule invasion

Question 5

MC type of functionality of adrenocortical carcinoma?

Answer 5

Cushings

Question 6

Treatment for adrenocortical carcinoma

Answer 6

En bloc resection, must r/o pheo 1st!

Question 7

What is the chemo drug used for metastatic adrenocortical carcinoma?

What is the survival benefit of this drug?

Answer 7

Mitotane (aka triple D; DDD)

No survival benefit, but tumor does shrink and is less functional

Question 8

Under what circumstances should you always pursue surgical intervention for an adrenal mass?

Answer 8

1. All adrenal tumors > 5cm on CT (b/c CT underest 1 cm on average)
2. All functional adrenal tumors
3. Suspected adrenocortical carcinoma