| Objective:To compare the clinical and pathological characterisitcs and laboratory test results of pheochromocytoma and paraganglioma based on 2017 WHO evaluation of adrenal tumor classification,and to provide relevant reference for improving the understanding of PHEO/PGL in clinic,then to evaluate the clinical application of GAPP scoring system under the new version of WHO evaluation of adrenal tumor classification.Methods: A retrospective study was conducted on 306 patients with PHEO/PGL admitted to the urology department of the Affiliated Hospital of Qingdao University from July 2008 to December 2018.The patients with PHEO/PGL were reclassified into high,medium and low differentiation groups according to the new classification criteria of WHO adrenal tumors in 2017 and the new scoring system(GAPP)proposed by Japanese scholars.The clinical data including pathology and prognosis of different groups were compared.Spearman rank correlation analysis was used to analyze the correlation between qualitative results of PNMT immunohistochemical staining and GAPP scores.According to GAPP scores,participants were divided into three groups,well-differentiated(0～2 points),moderately differentiated(3～6 points)and poorly differentiated(7～10 points),and the clinical data including pathology and prognosis of three groups were compared.Results:Among 306 patients with PHEO/PGL,244(79.74%)had hypertension symptoms,76(24.84%)had typical triad symptoms(dizziness,palpitation,hyperhidrosis),and the proportion of persistent hypertension symptoms and weight loss in patients with PGL were higher than those in patients with PHEO(all P<0.05).The level of norepinephrine(NE)in patients with PGL was higher than that in patients with PHEO(P<0.05),but there was no significant difference between PHEO and patients with PGL(P>0.05).The GAPP score of 306 patients with PHEO/PGL was(3.3±1.8).The GAPP score of patients with PGL was higher than that of patients with PHEO [(3.5 ± 1.7)vs(3.0 ± 1.9)],the difference was statistically significant(P<0.05).In the aspect of pathological evaluation of adrenal gland,the vascular/capsular invasion rate and the proportion of norepinephrine secretion in patients with PGL were significantly higher than those in patients with PHEO,and the proportion of adrenaline secretion was lower,the difference was statistically significant(all P<0.05).There was a negative correlation between GAPP score and PNMT immunohistochemical qualitative score in patients with PHEO/PGL,PHEO and PGL(all P<0.05).Among 306 patients,74 were highly differentiated(24.18%),189 were moderately differentiated(61.76%)and 43 were poorly differentiated(14.05%).The proportions of hypertension,typical triad symptoms,weight loss,blurred vision,abnormal glucose tolerance,myocardial injury,cerebral infarction,and renal insufficiency were statistically significant among the three groups(all P<0.05).The levels of adrenaline,norepinephrine,and dopamine in the poorly differentiated group were higher than those in the high and moderately differentiated group,and the urine creatinine concentration in the poorly differentiated group was also higher than the other two groups(all P<0.05).There were no significant differences in other laboratory indicators(all P> 0.05).Conclusion:1.There are certain differences in clinical manifestations,pathological characteristics,and laboratory test results among PHEO patients and PGL patients.PGL patients have a greater proportion of persistent hypertension,and the norepinephrine(NE)levels of PGL patients are higher than those of PHEO patients.2.There was a negative correlation between GAPP score and PNMT immunohistochemical qualitative score in PHEO/ PGL patients.GAPP classification is related to the clinical symptoms and laboratory test results of patients,which indicates that GAPP classification has certain guiding significance for the clinic. |
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