Was It an Adrenocortical Adenoma or an Adrenocortical Carcinoma? Limitation of the Weiss Scoring System in Determining the Malignant Potential of Adrenocortical Tumor: Report on Two Cases

Table 5

Suggested pathological diagnosis of the adrenocortical tumor at the first operation of Patient B based on different classification systems on retrospective pathology review. Only the Van Slooten system would have classified the tumor as ACC unequivocally.

Clinical features	Weiss	Hough	Van Slooten	Modified Weiss	Reticulin algorithm	Helsinki score
Case 2	No matching criteria	Thick fibrous band (1.00). Insufficient data on ACTH response, 24-hr urinary 17-ketosteroids, and tumor mass	Nuclear hyperchromatism (2.6). Regressive changes (5.7)	No matching criteria	Mandatory criteria not available and optional criteria not met	Criteria on mitoses and necrosis not met and PI not available
Score	0	At least 1.00	8.3	0	—	—
Classification based on system	ACA	Not clear	ACC	ACA	ACA	Not clear