MORPHOLOGICAL SPECTRUM OF PRIMARY ADRENAL TUMORS: CONTEMPORARY CONCEPTS AND DIAGNOSTIC CRITERIA
Keywords:
adrenal glands, adrenocortical tumor, pheochromocytoma, incidentaloma, immunohistochemistry, morphological verificationAbstract
This review article presents current perspectives on the morphological spectrum of primary adrenal tumors, with a focus on differential diagnosis, updated classification systems, and immunohistochemical and molecular verification. The increasing detection of adrenal incidentalomas is largely attributed to the widespread use of high-resolution imaging modalities; however, morphological verification often lags behind clinical diagnostics. Particular attention is given to the challenges in distinguishing between benign, malignant, and borderline lesions, as well as the implementation of risk stratification systems such as PASS and GAPP. Promising directions include the integration of digital pathology, artificial intelligence, and next-generation sequencing (NGS) platforms. The article highlights the urgent need for standardization of morphological approaches, especially in developing healthcare systems such as that of Uzbekistan.
References
Betts J.G., Desaix P., Johnson E., et al. Anatomy & Physiology. OpenStax CNX. July 27, 2023.
Chhabra S. et al. Paraganglioma: A Review of Histology and Molecular Aspects. Front Endocrinol, 2023, 14:1121397.
Cleveland Clinic medical professional. Pheochromocytoma: Causes, Symptoms & Treatment. June 30, 2022.
Crona J., Taïeb D., Pacak K. New perspectives on pheochromocytoma and paraganglioma: Toward a molecular classification. Nature Rev Endocrinol. 2023.
Fassnacht M., Arlt W., Bancos I. et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline. Eur J Endocrinol. 2020;183(1):G1–G17.
Fishbein L. et al. Comprehensive molecular characterization of pheochromocytoma and paraganglioma. Cancer Cell, 2023, 41(1):1–18.
Gruber L.M., Bancos I., Thompson G.B. et al. The Clinical Spectrum of Adrenal Incidentalomas. Endocr Rev. 2021;42(6):775–820.
Korpershoek E. et al. SDHB immunohistochemistry in adrenal and extra-adrenal paragangliomas: a valuable diagnostic tool. Histopathology, 2020, 76(3):385–396.
Lam A.K. Challenges in Paragangliomas and Pheochromocytomas: From Histology to Molecular Immunohistochemistry. Endocrine Pathology, 2020, 31(3):233–244.
Lenders J.W.M., Eisenhofer G., Mannelli M., Pacak K. Phaeochromocytoma. Lancet, 2020, 396(10267):665–675.
Mahmood E., Loughner C.L., Anastasopoulou C. Adrenal Adenoma. StatPearls Publishing. August 17, 2023.
Mete O., Erickson L.A., Juhlin C.C., et al. Overview of the 2022 WHO Classification of Adrenal Cortical Tumors. Endocr Pathol. 2022;33(2):155–177.
Neumann H.P.H., Young W.F. Jr, Eng C. Pheochromocytoma and Paraganglioma. N Engl J Med, 2019, 381(6):552–565.
Papathomas T.G., de Krijger R.R. Histopathology and molecular diagnostics of pheochromocytoma and paraganglioma. Clinical Endocrinology, 2021, 95(1):28–45.
Papathomas T.G., Duregon E., Volante M. et al. Adrenocortical tumours: updates and controversies in their classification and diagnosis. Histopathology. 2023;82(1):48–62.
Prete A., Taylor A.E., Bancos I. et al. Diagnosis and management of adrenal incidentalomas: updated recommendations from recent guidelines. Lancet Diabetes Endocrinol. 2022;10(3):210–222.
Terzolo M., Libè R., Fassnacht M. et al. Adrenocortical carcinoma: a comprehensive review. Lancet Oncol. 2023;24(2):e56–e72.
Volante M. et al. Validation of the prognostic role of the Helsinki Score in 225 cases of adrenocortical carcinoma. Hum Pathol. 2016;55:1–7.
WHO Classification of Tumours Editorial Board. WHO Classification of Tumours: Endocrine and Neuroendocrine Tumours. 5th ed. Lyon: IARC Press; 2022.
Wieneke J.A., Thompson L.D., Heffess C.S. Adrenal cortical neoplasms: a clinicopathologic study of 74 cases. Am J Surg Pathol. 2021;45(2):234–247.
Zhao L., Zhu Y., Chen W. et al. Advances in the pathology of adrenal gland neoplasms. Pathol Res Pract. 2021;222:153451.
Rakhimova Z.M., Normurodov Sh.A., Rakhmonov F.N. Adrenal endocrine tumors: structure and frequency based on the data from the Republican Specialized Scientific-Practical Medical Center of Endocrinology (Uzbekistan). Endocrinology of Uzbekistan. 2023;2(14):34–38 .(in Russ).
Nurmamatovich E. O., Makhammatkulovich R. N., Shavkatovna S. S. MARKER TNF-308G/A IN PATIENTS WITH RELATIVE BLADDER CANCER //World Bulletin of Public Health. – 2023. – Т. 28. – С. 95-97.
Ziyadullaev, S. K., Rakhimov, N. M., Elmamatov, O. N., & Esankulova, B. S. (2021). MARKER TNFα-308G/A IN PATIENTS WITH RELATIVE BLADDER CANCER. Oriental Renaissance: Innovative, educational, natural and social sciences, 1(8), 926-932.
Khomich L.M., Markov A.A., Polyakova A.A. Morphological verification of adrenal neoplasms: current state of the problem in the CIS countries. Oncological Pathology. 2021;18(4):45–52 .(in Russ).
