How to Differentiate Benign from Malignant Adrenocortical Tumors?
Adrenocortical carcinoma (ACC) is a rare cancer with a poor prognosis. Adrenal incidentalomas are, however, commonly identified in clinical practice. Discrimination between benign and malignant adrenal tumors is of great importance considering the large differences in clinical behavior requiring dif...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-08-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/17/4383 |
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| author | Charlotte L. Viëtor Sara G. Creemers Folkert J. van Kemenade Tessa M. van Ginhoven Leo J. Hofland Richard A. Feelders |
| author_facet | Charlotte L. Viëtor Sara G. Creemers Folkert J. van Kemenade Tessa M. van Ginhoven Leo J. Hofland Richard A. Feelders |
| author_sort | Charlotte L. Viëtor |
| collection | DOAJ |
| description | Adrenocortical carcinoma (ACC) is a rare cancer with a poor prognosis. Adrenal incidentalomas are, however, commonly identified in clinical practice. Discrimination between benign and malignant adrenal tumors is of great importance considering the large differences in clinical behavior requiring different strategies. Diagnosis of ACC starts with a thorough physical examination, biochemical evaluation, and imaging. Computed tomography is the first-level imaging modality in adrenal tumors, with tumor size and Hounsfield units being important features for determining malignancy. New developments include the use of urine metabolomics, also enabling discrimination of ACC from adenomas preoperatively. Postoperatively, the Weiss score is used for diagnosis of ACC, consisting of nine histopathological criteria. Due to known limitations as interobserver variability and lack of accuracy in borderline cases, much effort has been put into new tools to diagnose ACC. Novel developments vary from immunohistochemical markers and pathological scores, to markers at the level of DNA, methylome, chromosome, or microRNA. Molecular studies have provided insights into the most promising and most frequent alterations in ACC. The use of liquid biopsies for diagnosis of ACC is studied, although in a small number of patients, requiring further investigation. In this review, current diagnostic modalities and challenges in ACC will be addressed. |
| first_indexed | 2024-03-10T08:14:42Z |
| format | Article |
| id | doaj.art-880590c5875644fd91ade073a8ab4780 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T08:14:42Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-880590c5875644fd91ade073a8ab47802023-11-22T10:26:37ZengMDPI AGCancers2072-66942021-08-011317438310.3390/cancers13174383How to Differentiate Benign from Malignant Adrenocortical Tumors?Charlotte L. Viëtor0Sara G. Creemers1Folkert J. van Kemenade2Tessa M. van Ginhoven3Leo J. Hofland4Richard A. Feelders5Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, 3015GD Rotterdam, The NetherlandsDepartment of Internal Medicine, Division of Endocrinology, Erasmus MC University Medical Center, 3015GD Rotterdam, The NetherlandsDepartment of Pathology, Erasmus MC University Medical Center, 3015GD Rotterdam, The NetherlandsDepartment of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, 3015GD Rotterdam, The NetherlandsDepartment of Internal Medicine, Division of Endocrinology, Erasmus MC University Medical Center, 3015GD Rotterdam, The NetherlandsDepartment of Internal Medicine, Division of Endocrinology, Erasmus MC University Medical Center, 3015GD Rotterdam, The NetherlandsAdrenocortical carcinoma (ACC) is a rare cancer with a poor prognosis. Adrenal incidentalomas are, however, commonly identified in clinical practice. Discrimination between benign and malignant adrenal tumors is of great importance considering the large differences in clinical behavior requiring different strategies. Diagnosis of ACC starts with a thorough physical examination, biochemical evaluation, and imaging. Computed tomography is the first-level imaging modality in adrenal tumors, with tumor size and Hounsfield units being important features for determining malignancy. New developments include the use of urine metabolomics, also enabling discrimination of ACC from adenomas preoperatively. Postoperatively, the Weiss score is used for diagnosis of ACC, consisting of nine histopathological criteria. Due to known limitations as interobserver variability and lack of accuracy in borderline cases, much effort has been put into new tools to diagnose ACC. Novel developments vary from immunohistochemical markers and pathological scores, to markers at the level of DNA, methylome, chromosome, or microRNA. Molecular studies have provided insights into the most promising and most frequent alterations in ACC. The use of liquid biopsies for diagnosis of ACC is studied, although in a small number of patients, requiring further investigation. In this review, current diagnostic modalities and challenges in ACC will be addressed.https://www.mdpi.com/2072-6694/13/17/4383adrenal tumorsadrenocortical carcinomadiagnosticsmolecular markers |
| spellingShingle | Charlotte L. Viëtor Sara G. Creemers Folkert J. van Kemenade Tessa M. van Ginhoven Leo J. Hofland Richard A. Feelders How to Differentiate Benign from Malignant Adrenocortical Tumors? Cancers adrenal tumors adrenocortical carcinoma diagnostics molecular markers |
| title | How to Differentiate Benign from Malignant Adrenocortical Tumors? |
| title_full | How to Differentiate Benign from Malignant Adrenocortical Tumors? |
| title_fullStr | How to Differentiate Benign from Malignant Adrenocortical Tumors? |
| title_full_unstemmed | How to Differentiate Benign from Malignant Adrenocortical Tumors? |
| title_short | How to Differentiate Benign from Malignant Adrenocortical Tumors? |
| title_sort | how to differentiate benign from malignant adrenocortical tumors |
| topic | adrenal tumors adrenocortical carcinoma diagnostics molecular markers |
| url | https://www.mdpi.com/2072-6694/13/17/4383 |
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