Adrenal Cortical Neoplasm Scoring
Weiss, Modified Weiss, Reticulin, Lin-Weiss-Bisceglia, Helsinki, and Wieneke — six independent algorithms.
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Educational and decision-support tool only. This calculator applies CAP/WHO multiparameter scoring algorithms for adrenal cortical neoplasms and does not replace complete histopathologic evaluation, immunohistochemistry, clinical correlation, or professional pathologist judgment. Verify all criteria against the current edition of the applicable protocol before diagnostic use.
Reference
Overview
Applies the CAP protocol's multiparameter algorithms for adrenal cortical carcinoma. Malignancy is established if any one applicable system is positive — never an average, never a requirement that all systems agree.
Naming note: this calculator addresses adrenal cortical carcinoma criteria (Weiss, Modified Weiss, Reticulin, Lin-Weiss-Bisceglia, Helsinki, Wieneke). It does not cover pheochromocytoma or paraganglioma (adrenal medullary neuroendocrine tumor) grading, which use separate systems such as PASS or GAPP.
Tumor category → applicable panel
| Category | Applicable systems |
|---|---|
| Conventional (adult) | Weiss, Modified Weiss, Helsinki, Reticulin |
| Oncocytic | Lin-Weiss-Bisceglia, Helsinki, Reticulin |
| Myxoid | Weiss, Modified Weiss, Helsinki, Reticulin |
| Pediatric | Wieneke criteria (standalone) |
Threshold summary
| System | Threshold | Applicable categories |
|---|---|---|
| Weiss | ≥3 / 9 → carcinoma | Conventional, Myxoid |
| Modified Weiss | ≥3 / 7 → carcinoma | Conventional, Myxoid |
| Reticulin algorithm | Altered framework + ≥1 ancillary → malignant | Conventional, Oncocytic, Myxoid |
| Lin-Weiss-Bisceglia | Any major → carcinoma; any minor only → UMP | Oncocytic only |
| Helsinki | >8.5 → carcinoma; >17 → adverse prognosis | Conventional, Oncocytic, Myxoid |
| Wieneke | ≥4 → malignant; =3 → UMP; ≤2 → benign | Pediatric only (standalone) |
Two mitotic definitions
Weiss/Modified Weiss/Reticulin/LWB/Helsinki use >5 per 10 mm² (50 HPF). Wieneke uses >15 per 4 mm² (20 HPF). These are never interchangeable.
Weiss criteria (1 point each)
| Criterion | Points |
|---|---|
| High Fuhrman nuclear grade (III or IV) | 1 |
| Mitotic count >5 per 10 mm² (50 HPF) | 1 |
| Atypical mitosis | 1 |
| Necrosis | 1 |
| Diffuse architecture >30% of tumor volume | 1 |
| Clear cells ≤25% of tumor volume | 1 |
| Capsular invasion | 1 |
| Venous invasion | 1 |
| Sinusoidal (lymphatic) invasion | 1 |
Modified Weiss criteria
| Criterion | Points |
|---|---|
| Mitotic count >5 per 10 mm² (50 HPF) | 2 |
| Clear cells in ≤25% | 2 |
| Atypical mitosis | 1 |
| Necrosis | 1 |
| Capsular invasion | 1 |
Reticulin algorithm
An algorithm, not an additive score: an altered reticulin framework plus at least one ancillary feature (mitotic count >5 per 10 mm², tumor necrosis, or vascular invasion) indicates malignancy. An intact framework does not indicate malignancy regardless of ancillary findings.
Lin-Weiss-Bisceglia (oncocytic)
Any one major criterion is sufficient for carcinoma. Minor criteria are only evaluated once major criteria are confirmed absent: any minor criterion alone indicates uncertain malignant potential; none indicates adenoma.
| Criterion | Type |
|---|---|
| Mitoses >5 per 10 mm² (50 HPF) | Major |
| Atypical mitosis | Major |
| Venous invasion | Major |
| Sinusoidal (lymphatic) invasion | Major |
| Large size (>10 cm and/or >200 g) | Minor |
| Necrosis | Minor |
| Capsular invasion | Minor |
Helsinki score
Score = 3 × (mitoses >5 per 10 mm²) + 5 × (necrosis) + Ki-67 proliferation index (%, added as raw value). A score >8.5 indicates carcinoma; >17 is an additional adverse-prognosis flag, not a separate diagnosis.
The original study used automated image analysis for Ki-67 assessment. Manual estimation should follow a validated methodology.
Wieneke criteria (pediatric, 1 point each)
Total ≥4 → malignant / poor clinical outcome; 3 → uncertain malignant potential; ≤2 → benign behavior.
| Criterion | Points |
|---|---|
| Tumor weight >400 g | 1 |
| Tumor size >10.5 cm | 1 |
| Extension into periadrenal soft tissue or adjacent organs | 1 |
| Invasion into vena cava | 1 |
| Venous invasion (vascular invasion) | 1 |
| Capsular invasion | 1 |
| Presence of tumor necrosis | 1 |
| Mitoses >15 per 4 mm² (20 HPF) | 1 |
| Presence of atypical mitosis | 1 |
Sources
College of American Pathologists (CAP). Protocol for the Examination of Resection Specimens From Patients With Carcinoma of the Adrenal Cortex.
WHO Classification of Tumours Editorial Board. WHO Classification of Tumours: Endocrine and Neuroendocrine Tumours. 5th ed. IARC.
Each scoring system (Weiss, Modified Weiss, Reticulin algorithm, Lin-Weiss-Bisceglia, Helsinki, Wieneke) originates from its own primary publication, cited within the current CAP protocol and WHO classification. This calculator does not cover pheochromocytoma or paraganglioma grading.