March 28, 2026

Clinicopathological and imaging features of pediatric adrenocortical carcinoma: compared with non-carcinoma

Key Result

Fibrous septa with small blood-feeding arteries (OR 15.62) and the Ki-67 labeling index (OR 1.16) independently predicted pediatric adrenocortical carcinoma with an AUC of 0.962.

Key Points

To explore differences in clinicopathological and imaging features between pediatric adrenocortical carcinoma and non-carcinoma.
Reviewed clinicopathological and imaging findings of 32 children with adrenocortical tumors.
Conducted comparisons among adenomas, uncertain malignant potential, and carcinomas.
Used multivariate logistic regression to identify independent predictive factors.
Median age of children with ACC was 3 years, with significant differences noted in tumor size and internal necrosis.
ACC tumors were larger, often showed calcifications and distant metastasis.
Significant statistical differences were found in imaging measurements and the Ki-67 labeling index.

Structured PICO

What are the clinicopathological and imaging features that differentiate pediatric adrenocortical carcinoma from non-carcinoma?

Population

Thirty-two children with pathologically proven adrenocortical tumors (ACT) (10 adenomas, 10 with uncertain malignant potential, and 12 carcinomas)

Intervention

Clinicopathological and imaging (CT/MR) evaluation

Comparator

Non-carcinoma (adenomas and uncertain malignant potential)

Outcome

Differences in clinicopathological and imaging features between pediatric ACC and non-carcinomasurrogate

Fibrous septa with small blood-feeding arteries and the Ki-67 labeling index are strong independent predictors for differentiating pediatric adrenocortical carcinoma from non-carcinoma.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Objectives To explore the differences in clinicopathological and imaging features between pediatric adrenocortical carcinoma (ACC) and non-carcinoma. Methods The clinicopathological and imaging (CT/MR) findings of thirty-two children with pathologically proven adrenocortical tumors (ACT) (10 adenomas, 10 with uncertain malignant potential, and 12 carcinomas) were reviewed and compared retrospectively. Multivariate logistic regression was used further to explore the independent predictive factors for ACC and non-carcinoma. Results The median age of children with ACC was 3 years old, with an IQR (interquartile range) of 1.813-4.375 years old. ACC was larger and more likely to be accompanied by extensive internal necrosis, calcification, and distant metastasis. ACC commonly showed a spoke-wheel enhanced pattern and peripheral fibrous septa with small blood-feeding arteries. There were significant statistical differences among these three groups in the maximum value of unenhanced CT, the maximum and skewness value in the venous phase, the minimum ADC value, and Ki-67 labeling index (p = 0.02, 0.003, 0.022, 0.002, and 0.000). The fibrous septa with small blood-feeding arteries and Ki-67 labeling index were independent predictive factors for the prediction of ACC and non-carcinoma, with p values and OR values of 0.038 and 15.62, and 0.011 and 1.16. And the AUC, the accuracy, the sensitivity, and specificity were 0.962 (95% CI: 0.828-0.998), 90.62%, 100%, and 85%, respectively. Conclusions Pediatric ACC was larger and was commonly accompanied by extensive internal necrosis, calcification, and distant metastasis. Fibrous septa with small blood-feeding arteries and the Ki-67 labeling index were independent predictors of ACC. ADVANCES IN KNOWLEDGE Pediatric ACC showed a spoke-wheel enhanced pattern and peripheral fibrous septa with small blood-feeding arteries. The fibrous septa with small blood-feeding arteries and Ki-67 labeling index were independent predictive factors for the differentiation of ACC and non-carcinoma.

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