World Journal of Endocrine Surgery

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VOLUME 15 , ISSUE 3 ( September-December, 2023 ) > List of Articles

Original Article

Utility of Reticulin Algorithm in Diagnosis of Adrenocortical Tumors: A Re-visit

Jyotsna Yesodharan, Jyothin Benchamin, Bindhu M Rajamma

Keywords : Adenoma, Adrenal cortical neoplasm, Carcinoma, Reticulin algorithm

Citation Information : Yesodharan J, Benchamin J, Rajamma BM. Utility of Reticulin Algorithm in Diagnosis of Adrenocortical Tumors: A Re-visit. World J Endoc Surg 2023; 15 (3):63-66.

DOI: 10.5005/jp-journals-10002-1462

License: CC BY-NC 4.0

Published Online: 20-04-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: This study aimed primarily at the assessment of the usefulness of the reticulin algorithm (RA) in the diagnosis of adrenocortical tumors in comparison with conventional multiparametric reporting systems in routine use. Materials and methods: It was a retrospective study and included 40 adrenocortical tumors reported between 2013 and 2021 in the histopathology division of our institute, a tertiary care center in Kerala, South India. The demographic, clinical, and biochemical profiles, as well as macroscopic details of these cases, were recorded, and selected formalin-fixed paraffin-embedded blocks of the tumor were stained for reticulin fibers by Foot's modification. The two-step RA, which defines malignancy through a qualitative/quantitative alteration in reticulin framework along with at least one of the three histopathological parameters i.e., necrosis, venous invasion, and high mitotic rate, was applied to all tumors. The diagnosis thus obtained was compared with the original histopathology report based on the conventional scoring systems. Results: Our cohort included 28 cases originally reported as adrenocortical adenomas and 12 as adrenocortical carcinomas (ACC) as per the classical scoring systems. On application of the two-step RA, all carcinomas were diagnosed correctly with diffusely altered reticulin framework. All but one case in the adenoma group were rightly classified as adenoma as per the RA as they failed to meet the two-tiered requirements for a diagnosis of carcinoma. The single discordant case was that of a huge adenoma with extensive hemorrhage, cystic degeneration, and necrosis, which showed only qualitative reticulin alterations probably attributable to the degenerative changes and lacked vascular invasion and high mitotic rate. Conclusion: The RA provides a fast, cheap, and easy-to-apply method for the diagnosis of ACCs with good reproducibility and reduces dependence on multiple other morphological parameters included in conventional scoring systems, thus bringing down subjectivity. However, the procedure of reticulin staining is technically demanding, and extreme caution needs to be exercised at every step for good results.

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