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

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.

• Authors: Kerollos N Wanis, Rani Kanthan
• Journal: World journal of surgical oncology (World J Surg Oncol) Vol. 13 Pg. 117 (Mar 24 2015) ISSN: 1477-7819 [Electronic] England
• PMID: 25889798 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Biomarkers, Tumor

Topics

• Adrenal Cortex Neoplasms (metabolism, pathology, surgery)
• Adrenocortical Carcinoma (metabolism, pathology, surgery)
• Adult
• Aged
• Biomarkers, Tumor (metabolism)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Prognosis