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Table 5 Hough system criteria

From: Diagnostic and prognostic features in adrenocortical carcinoma: a single institution case series and review of the literature

Criteria Numeric value
Diffuse growth pattern 0.92
Vascular invasion 0.92
Tumor cell necrosis 0.69
Broad fibrous bands 1.00
Capsular invasion 0.37
Mitotic index (>1/10 HPFs) 0.60
Pleomorphism 0.39
Tumor mass (>100 g) 0.60
Urinary 17-ketosteroids (10 mg/1 g creatinine 24 h) 0.50
Response to ACTH (17-hydroxysteroids increased two times after 50 mcg of IV ACTH) 0.42
Cushing syndrome with virilism, virilism alone, or no clinical manifestations 0.42
Weight loss (>10 lb/3 months) 2.00
  1. ACTH, adrenocorticotropic hormone; HPFs, high-powered fields.