Adrenocortical carcinoma in children: First population‑based clinicopathological study with long-term follow-up

Kerkhofs,T. M.A.; Ettaieb,M. H.T.; Verhoeven,R. H.A.; Kaspers,G. J.L.; Tissing,W. J.E.; Loeffen,J.; Van den Heuvel-Eibrink,M. M.; De Krijger,R. R.; Haak,H. R.

doi:10.3892/or.2014.3506

Adrenocortical carcinoma in children: First population‑based clinicopathological study with long-term follow-up

Authors:
- T. M.A. Kerkhofs
- M. H.T. Ettaieb
- R. H.A. Verhoeven
- G. J.L. Kaspers
- W. J.E. Tissing
- J. Loeffen
- M. M. Van den Heuvel-Eibrink
- R. R. De Krijger
- H. R. Haak
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Affiliations: Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, The Netherlands, Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre The Netherlands, Eindhoven, The Netherlands, Department of Pediatric Oncology and Hematology, VU University Medical Centre, Amsterdam, The Netherlands, Department of Pediatric Oncology and Hematology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands, Department of Pediatric Oncology and Hematology, University Medical Central St. Radboud, Nijmegen, The Netherlands, Department of Pediatric Oncology and Hematology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands, Department of Pathology, Reinier de Graaf Hospital, Delft, The Netherlands
Published online on: September 22, 2014 https://doi.org/10.3892/or.2014.3506
Pages: 2836-2844

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Abstract

Adrenocortical carcinoma (ACC) is rare in both adult and pediatric populations. Literature suggests significant differences between children and adults in presentation, histological properties and outcome. The aim of this first nationwide study on pediatric ACC was to describe the incidence, presentation, pathological characteristics, treatment and survival in The Netherlands. All ACC patients aged <20 years at diagnosis and registered in the population-based Netherlands Cancer Registry between 1993 and 2010 were included. Clinical data were extracted from medical records. Archival histological slides were collected via the Dutch Pathology Registry (PALGA). We compared our findings to all clinical studies on pediatric ACC that were found on PubMed. Based on the results, 12 patients were identified: 8 females and 4 males. The median age was 4.1 years (range 1.1-18.6). The population-based age-standardized incidence rate for patients <20 years was 0.18 per million person-years. Autonomous hormonal secretion was present in 10 patients. Seven patients were aged ≤4 years at diagnosis, 5 presented with localized disease and 2 with locally advanced disease. Five patients were aged ≥5 years, 3 presented with distant metastases and 1 with locally advanced disease. For all patients, histological examination displayed malignant characteristics. All patients aged ≤4 years at diagnosis survived; the median follow-up was 97 months (57-179 months). All patients aged ≥5 years died; the median survival was 6 months (0-38 months). Pediatric ACC is extremely rare in the Western world. The clinical outcome was remarkably better in patients aged ≤4 years. This is in accordance with less advanced stage of disease at presentation, yet contrasts with the presence of adverse histological characteristics. Clinical management in advanced disease is adapted from adult practice in the absence of evidence regarding pediatric ACC.

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