Adrenal gland & paraganglia
General
Staging-adrenal cortical carcinoma
Last author update: 9 June 2020
Last staff update: 3 October 2024
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Staging-adrenal cortical carcinoma
Cite this page: Zynger DL. Staging-adrenal cortical carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/adrenalstaging.html. Accessed December 22nd, 2024.
Definition / general
- All carcinomas of the adrenal gland are covered by this staging system
- These topics are not covered: pheochromocytoma, neuroblastic tumors
Essential features
- AJCC 7th edition staging was sunset on December 31, 2017; as of January 1, 2018, use of the 8th edition is mandatory
ICD coding
- ICD-O-3: C74.0 - cortex of the adrenal gland
Primary tumor (pT)
- pTX: cannot be assessed
- pT0: no evidence of primary tumor
- pT1: tumor ≤ 5 cm, no extra-adrenal invasion
- pT2: tumor > 5 cm, no extra-adrenal invasion
- pT3: extra-adrenal invasion but no invasion of adjacent organs
- pT4: invasion of kidney, diaphragm, pancreas, spleen, liver, renal vein or vena cava
Regional lymph nodes (pN)
- pNX: cannot be assessed
- pN0: no regional lymph node metastasis
- pN1: regional lymph node metastasis (e.g., paraaortic, periaortic, retroperitoneal)
AJCC prognostic stage groups
| Stage group I: | T1 | N0 | M0
|
| Stage group II: | T2 | N0 | M0
|
| Stage group III: | T1 - 2 | N1 | M0
|
| T3 - 4 | N0 - 1, X | M0
|
| Stage group IV: | T1 - 4, X | N0 - 1, X | M1
|
Registry data collection variables
- Tumor weight
- Vascular invasion
- Mitotic count
- Ki67 proliferation index
- Weiss score
Histologic grade (G)
- Low grade: ≤ 20 mitoses per high powered field
- High grade: > 20 mitoses per high powered field; TP53 or CTNNB mutation
Histopathologic type
- Oncocytic
- Myxoid
- Sarcomatoid
Gross images
Contributed by Debra Zynger, M.D.
Organ confined, ≤ 5 cm (pT1)
Organ confined, > 5 cm (pT2)
Extra-adrenal invasion (pT3)
Liver invasion (pT4)
Microscopic (histologic) images
Contributed by Debra Zynger, M.D. and Maria Tretiakova, M.D., Ph.D.
Extra-adrenal adipose invasion (pT3)
Liver involvement (pT4)
Regional node involvement (pN1)
Board review style question #1
The adrenal cortical carcinoma shown above has invasion of the extra-adrenal adipose tissue but does not invade adjacent organs. What is the correct pT for this tumor?
- pT1
- pT2
- pT3
- pT4
Board review style answer #1
C. pT3. Adrenal cortical carcinoma with extra-adrenal adipose invasion is pT3. pT1 tumors are organ confined and ≤ 5 cm. pT2 tumors are organ confined and > 5 cm. pT4 tumors show direct invasion of adjacent structures including the kidney, diaphragm, pancreas, spleen, liver, renal vein or vena cava.
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Reference:
Staging-adrenal cortical carcinoma
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