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Maria Riedmeier, Lester D R Thompson, Carlos Augusto Fernandes Molina, Boris Decarolis, Christoph Härtel, Paul-G Schlegel, Martin Fassnacht, and Verena Wiegering

. According to the modified Weiss scoring system, tumors are classified as ACC if three or more criteria were present ( Table 1 ) ( Weiss 1984 , Weiss et al. 1989 ). Discrepancies between Weiss scoring criteria and clinical outcome in terms of

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P S H Soon, A J Gill, D E Benn, A Clarkson, B G Robinson, K L McDonald, and S B Sidhu

) can be difficult. The Weiss score, a nine-point histopathological scoring system, is presently the most widely used system for classifying adrenocortical tumors (ACTs) as benign or malignant. A total score of ≤2 is typically associated with a benign

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S G Creemers, R A Feelders, N Valdes, C L Ronchi, M Volante, B M van Hemel, M Luconi, M H T Ettaieb, M Mannelli, M D Chiara, M Fassnacht, M Papotti, M N Kerstens, G Nesi, H R Haak, F J van Kemenade, and L J Hofland

2010 ). Only in rare cases, the adrenal tumor has malignant potential. Adrenocortical carcinoma (ACC) is a highly malignant tumor with 5-year-survival ranging from 16 to 38% ( Kebebew et al. 2006 , Fassnacht et al. 2013 ). The Weiss score (WS

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Maria Cristina De Martino, Richard A Feelders, Wouter W de Herder, Peter M van Koetsveld, Fadime Dogan, Joseph A M J L Janssen, A Marlijn Waaijers, Claudia Pivonello, Steven W J Lamberts, Annamaria Colao, Ronald R de Krijger, Rosario Pivonello, and Leo J Hofland

. This study was approved by the Medical Ethics Committee of the Erasmus Medical Center. The Weiss score, assessed by an expert pathologist in adrenal disease (RRdK), was used to make the distinction between adenomas and carcinomas ( Weiss 1984 ). The

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S G Creemers, L J Hofland, E Korpershoek, G J H Franssen, F J van Kemenade, W W de Herder, and R A Feelders

during surgery ( Song et al . 2011 ). Pathology The Weiss score (WS) is currently the most widely used classification system for the pathological assessment of adrenocortical tumors ( Weiss 1984 , Lau & Weiss 2009 ). It consists of nine morphological

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Rossella Libè, Amato Fratticci, and Jérôme Bertherat

region 11p15 LOH is associated with a higher risk of tumor recurrence, is more frequent in ACC than in adrenal adenomas (78.5 vs 9.5%) and correlates with Weiss score (a score of cytopathological alterations used for the diagnosis of malignancy, see below

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S G Creemers, P M van Koetsveld, F J van Kemenade, T G Papathomas, G J H Franssen, F Dogan, E M W Eekhoff, P van der Valk, W W de Herder, J A M J L Janssen, R A Feelders, and L J Hofland

surgery ( Lacroix 2010 ). However, the discrimination of ACCs from adrenocortical adenomas (ACAs) still remains challenging on both imaging and postoperative histopathological grounds. The current pathological scoring system (Weiss score) is limited by a

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B Wängberg, A Khorram-Manesh, S Jansson, B Nilsson, O Nilsson, C E Jakobsson, S Lindstedt, A Odén, and H Ahlman

examination of resected tumours (atypical light microscopical features and immunohistochemical profiles; Weiss et al . 2004 ). The malignant potential was assessed by Weiss scoring. In patients with non-resectable disease, tumour-reducing procedures were

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Ziwei Zhang, Menglian Li, Jianjun Wang, Mengsi Liu, Huan Chen, Yuan Lou, Yijie Wang, Qi Sun, Dalong Zhu, Ping Li, and Yan Bi

Weiss scores of 1 to 3, whereas 46 (85.2%) patients had high Weiss scores of 4 to 9. Of the four patients with Weiss scores less than 3, one was diagnosed with adrenocortical carcinoma according to Lin–Weiss–Bisceglia criteria and the other three were

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Elisa Roca, Alfredo Berruti, Silviu Sbiera, Ida Rapa, Ester Oneda, Paola Sperone, Cristina L Ronchi, Laura Ferrari, Salvatore Grisanti, Antonina Germano, Barbara Zaggia, Giorgio Vittorio Scagliotti, Martin Fassnacht, Marco Volante, Massimo Terzolo, and Mauro Papotti

disease. The diagnosis of ACC was based on the pathological Weiss score ( Weiss et al . 1989 ). Variables recorded included age, sex, hormone secretion, ENSAT stage at diagnosis ( Fassnacht et al . 2009 ), initial therapeutic options including primary