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

Wanis KN, Kanthan R - World J Surg Oncol (2015)

Bottom Line: Abnormal Β-catenin intracellular accumulation was noted in four of the eight tumors.The two tumors in our series with sarcomatoid histology did not stain positively for SF-1 or inhibin.Diffuse p53 staining showed a trend for positive correlation with increased Ki-67 expression.

View Article: PubMed Central - PubMed

Affiliation: College of Medicine, University of Saskatchewan, Saskatoon, Canada. knw047@mail.usask.ca.

ABSTRACT

Background: Adrenocortical carcinoma is a rare cancer, with an incidence in the literature of 0.5 to 2 cases per million population per year. Adult adrenocortical carcinoma has a poor prognosis, underscoring the importance of identifying diagnostic and prognostic markers.

Methods: We searched our laboratory database for all cases in the past 15 years with a diagnosis of adrenocortical carcinoma. The original slides were then reviewed for their histopathological features. A representative paraffin block was subjected to further immunohistochemical staining for Ki-67, inhibin, steroidogenic factor-1 (SF-1), p53, and Β-catenin. These slides were scored by the study pathologist who was blinded to all clinicopathological data. In addition, a comprehensive review of the relevant English literature in the past 15 years was conducted.

Results: Eight cases were identified, including two adrenal sarcomatoid carcinomas. Seven of the eight cases had a disrupted reticulin network. Six of the eight tumors had >10% Ki-67 expression. Five of the eight tumors had >10% p53 expression. Positive inhibin immunohistochemical staining was seen in three of the eight tumors, and positive SF-1 staining was seen in five of the seven stained tumors. Abnormal Β-catenin intracellular accumulation was noted in four of the eight tumors. The two tumors in our series with sarcomatoid histology did not stain positively for SF-1 or inhibin.

Conclusions: Eight cases of adrenocortical carcinoma, including two with sarcomatoid features are presented. The two sarcomatoid adrenocortical carcinomas in our series did not stain for SF-1 which suggests a possible de novo pathway of tumorigenesis for this rare variant. The reticulin staining method was a useful tool for rapid differentiation of adrenocortical adenomas and carcinomas. Diffuse p53 staining showed a trend for positive correlation with increased Ki-67 expression. Inhibin staining was inconsistently expressed in our cases of adrenocortical carcinoma. In conclusion, as adrenocortical carcinoma is a rare disease, we recommend future multicenter studies with appropriate sample sizes to further evaluate the efficacy of these diagnostic and prognostic markers.

No MeSH data available.


Related in: MedlinePlus

Photomicrograph showing (a) malignant cells with marked nuclear pleomorphism (#) and the presence of a multinucleated tumor giant cell (*) and (b) sarcomatoid areas with spindled cells in a myxomatous background.
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Fig2: Photomicrograph showing (a) malignant cells with marked nuclear pleomorphism (#) and the presence of a multinucleated tumor giant cell (*) and (b) sarcomatoid areas with spindled cells in a myxomatous background.

Mentions: Case 7 in Tables 2 and 3 is a 68-year-old lady who was incidentally found to have a large adrenal tumor during follow-up imaging for a previous lung adenocarcinoma. She had a radical nephrectomy. The adrenal tumor measured 13.0 × 11.0 × 9.0 cm. Microscopically, much of the tumor was hemorrhagic and necrotic. The neoplasm showed marked pleomorphism with frequent multinucleated giant cells as seen in Figure 2a. There were epithelioid areas and sarcomatoid areas with spindled cells in a myxomatous background as seen in Figure 2b. There were numerous typical mitoses, five per single HPF in some areas, and atypical mitoses. In agreement with WHO recommendations, this is a sarcomatoid carcinoma [7]. This patient had disease recurrence invading the gastroduodenal artery within 68 days. She required multiple transfusions and embolization of the artery for control of bleeding. She succumbed to her disease 223 days after initial surgery.Figure 2


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

Wanis KN, Kanthan R - World J Surg Oncol (2015)

Photomicrograph showing (a) malignant cells with marked nuclear pleomorphism (#) and the presence of a multinucleated tumor giant cell (*) and (b) sarcomatoid areas with spindled cells in a myxomatous background.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4384320&req=5

Fig2: Photomicrograph showing (a) malignant cells with marked nuclear pleomorphism (#) and the presence of a multinucleated tumor giant cell (*) and (b) sarcomatoid areas with spindled cells in a myxomatous background.
Mentions: Case 7 in Tables 2 and 3 is a 68-year-old lady who was incidentally found to have a large adrenal tumor during follow-up imaging for a previous lung adenocarcinoma. She had a radical nephrectomy. The adrenal tumor measured 13.0 × 11.0 × 9.0 cm. Microscopically, much of the tumor was hemorrhagic and necrotic. The neoplasm showed marked pleomorphism with frequent multinucleated giant cells as seen in Figure 2a. There were epithelioid areas and sarcomatoid areas with spindled cells in a myxomatous background as seen in Figure 2b. There were numerous typical mitoses, five per single HPF in some areas, and atypical mitoses. In agreement with WHO recommendations, this is a sarcomatoid carcinoma [7]. This patient had disease recurrence invading the gastroduodenal artery within 68 days. She required multiple transfusions and embolization of the artery for control of bleeding. She succumbed to her disease 223 days after initial surgery.Figure 2

Bottom Line: Abnormal Β-catenin intracellular accumulation was noted in four of the eight tumors.The two tumors in our series with sarcomatoid histology did not stain positively for SF-1 or inhibin.Diffuse p53 staining showed a trend for positive correlation with increased Ki-67 expression.

View Article: PubMed Central - PubMed

Affiliation: College of Medicine, University of Saskatchewan, Saskatoon, Canada. knw047@mail.usask.ca.

ABSTRACT

Background: Adrenocortical carcinoma is a rare cancer, with an incidence in the literature of 0.5 to 2 cases per million population per year. Adult adrenocortical carcinoma has a poor prognosis, underscoring the importance of identifying diagnostic and prognostic markers.

Methods: We searched our laboratory database for all cases in the past 15 years with a diagnosis of adrenocortical carcinoma. The original slides were then reviewed for their histopathological features. A representative paraffin block was subjected to further immunohistochemical staining for Ki-67, inhibin, steroidogenic factor-1 (SF-1), p53, and Β-catenin. These slides were scored by the study pathologist who was blinded to all clinicopathological data. In addition, a comprehensive review of the relevant English literature in the past 15 years was conducted.

Results: Eight cases were identified, including two adrenal sarcomatoid carcinomas. Seven of the eight cases had a disrupted reticulin network. Six of the eight tumors had >10% Ki-67 expression. Five of the eight tumors had >10% p53 expression. Positive inhibin immunohistochemical staining was seen in three of the eight tumors, and positive SF-1 staining was seen in five of the seven stained tumors. Abnormal Β-catenin intracellular accumulation was noted in four of the eight tumors. The two tumors in our series with sarcomatoid histology did not stain positively for SF-1 or inhibin.

Conclusions: Eight cases of adrenocortical carcinoma, including two with sarcomatoid features are presented. The two sarcomatoid adrenocortical carcinomas in our series did not stain for SF-1 which suggests a possible de novo pathway of tumorigenesis for this rare variant. The reticulin staining method was a useful tool for rapid differentiation of adrenocortical adenomas and carcinomas. Diffuse p53 staining showed a trend for positive correlation with increased Ki-67 expression. Inhibin staining was inconsistently expressed in our cases of adrenocortical carcinoma. In conclusion, as adrenocortical carcinoma is a rare disease, we recommend future multicenter studies with appropriate sample sizes to further evaluate the efficacy of these diagnostic and prognostic markers.

No MeSH data available.


Related in: MedlinePlus