摘要目的:探讨肾上腺皮质嗜酸细胞肿瘤（adrenocortical oncocytic tumors，ACOT）的临床病理特征，对比分析Lin-Weiss-Bisceglia（LWB）评分及赫尔辛基评分两种评分标准的病理诊断应用价值。方法:回顾性分析首都医科大学附属北京友谊医院2008年3月至2019年7月诊断的44例ACOT，进行形态学观察，依照两种评分标准重新评估良恶性。免疫组织化学采用EnVision染色。结果:患者男性23例，女性21例，平均年龄46岁。镜下见肿瘤可呈小梁状、菊形团、腺样及微囊结构排列，透明细胞稀少或无，细胞多数有中度异型性，核内包涵体易见。免疫组织化学染色表达Melan A、α抑制素、突触素、calretinin，Ki-67平均阳性指数：良性3%、恶性潜能约5%、恶性多数>20%。依据LWB评分，左侧多发，占61.4%（27/44）；良性59.1%（26/44），恶性潜能6.8%（3/44），恶性34.1%（15/44），15例恶性病变中13例可见核分裂象>5个/50 HPF，11例伴有坏死，10例伴有包膜侵犯。依据赫尔辛基评分，良性65.9%（29/44），恶性34.1%（15/44），两种评分结果差异无统计学意义（ P>0.05）。随访9~144个月，无病存活31例，复发或转移13例。 结论:ACOT良性多见，左侧多发，恶性者易复发及转移。LWB评分标准中形态学参数（核分裂计数增多、坏死和包膜侵犯）联合赫尔辛基评分免疫组织化学参数（Ki-67）有助于恶性ACOT的诊断，并且是重要的预后参考指标。

abstractsObjective:To study the clinicopathological features of adrenocortical oncocytic tumors (ACOT) and to compare the diagnostic values of Lin-Weiss-Bisceglia (LWB) score and Helsinki score.Methods:Forty-four cases of ACOT diagnosed at Beijing Friendship Hospital, China from March 2008 to July 2019 were histologically analyzed to evaluate their malignant potential (benign versus malignant) according to two scoring criteria. Immunohistochemical studies (EnVision method) were also used.Results:There were 23 males and 21 females with an average age of 46 years. Histologically, the tumor cells were arranged in trabecular, chrysanthemum-shaped, glandular and microcapsule structures, while clear cells were rare or absent. Most of the tumor cells were moderately atypical, and intranuclear inclusion bodies were conspicuous. Immunohistochemical staining showed that tumor cells were positive for Melan A, inhibin, Syn and calretinin. The average proliferation index was 3% in benign ACOT, about 5% in ACOT of malignant potential, and>20% in malignant ACOT. According to the LWB score, 61.4% (27/44) of the tumors were on the left side and had multiple lesions. The percentage of benign ACOT was 59.1% (26/44), malignant potential 6.8% (3/44), malignant 34.1% (15/44), respectively. Among the 15 malignant ACOT, the mitotic figures>5/50 HPF were found in 13 cases, necrosis in 11 cases and capsule invasion in 10 cases. According to the Helsinki score, 65.9% (29/44) of the tumors were benign, and 34.1% (15/44) were malignant. There was no significant difference between the two scoring standards ( P>0.05). During the follow-up of 9 to 144 months, 31 patients survived without disease and 13 patients relapsed or had metastasis. Conclusions:ACOT more likely be benign than malignant. The left side is more common. Malignant tumors are prone to recurrence and metastasis. The morphological parameters (high mitotic index, necrosis, and capsular invasion) in the LWB scoring standards combined with immunohistochemical parameters (Ki-67) in the Helsinki score are helpful for the diagnosis of malignant ACOT and are important predictors of poor prognosis.