Современные диагностические критерии адренокортикальных опухолей: от морфологии к молекулярной классификации

Диагностика адренокортикальных опухолей существенно улучшилась за последнее время благодаря внедрению воспроизводимых морфологических шкал в сочетании с валидированными иммуногистохимическими и молекулярными маркерами. Изменения в классификации адренокортикальных опухолей WHO-2025, консенсусы ICCR и современные клинические рекомендации усилили требования к стандартам морфологической диагностики, определению ИГХ-профиля и интерпретации полученных результатов.

Цель исследования. Систематизировать современные морфологические, иммуногистохимические и молекулярные критерии адренокортикальных опухолей и представить практический алгоритм их поэтапного применения в патологоанатомической диагностике.

Материалы и методы. Аналитический обзор публикаций 2021–2025 гг. по патологической анатомии и молекулярной онкоэндокринологии адренокортикальных опухолей, включая WHO-2025, наборы данных ICCR, обновления европейских рекомендаций и многоцентровые когорты.

Результаты. Классические морфологические критерии, которые включают в себя оценку митотической активности, капсулярной и сосудистой инвазии, а также признаки клеточной атипии, остаются одними из основных при диагностике адренокортикальных опухолей. В обзоре систематизированы ключевые морфологические инструменты: критерии Weiss/модифицированные, Helsinki-score, ретикулиновый алгоритм; уточнены диагностические особенности онкоцитарных (Lin-Weiss-Bisceglia), миксоидных и педиатрических вариантов адренокортикальных опухолей. Обобщены данные о роли SF-1 как высокоспецифичного маркера коркового происхождения; высокого индекса Ki-67 – как важнейшего диагностического и прогностического показателя злокачественности новообразований (с учетом порогов и строгих требований к методике подсчета); повышенной экспрессии IGF2 – как дополнительного маркера злокачественности. Представлена обобщенная сводная характеристика молекулярных драйверов (TP53, CTNNB1/β-катенин, ZNRF3, TERT-promoter), метилируемые подписи и сигнатуры miRNA (miR-483), а также вклад одноядерной/ пространственной транскриптомики и неинвазивных биомаркеров (стероидный метаболом, жидкая биопсия).

Заключение. Переход к интегральной морфомолекулярной стратификации повышает диагностическую и прогностическую точность при адренокортикальных опухолях, обеспечивает сопоставимость отчетов и облегчает отбор пациентов для наблюдения и терапии.

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