• Discerning malignancy in resected adrenocortical neoplasms.

• Pathologic features and expression of insulin-like growth factor-2 in adrenocortical neoplasms.

• The natural history of incidentally discovered adrenocortical adenomas: a retrospective evaluation.

• Test and teach. Surgically correctable hypertension. Conn's syndrome and spironolactone bodies.

• [Female pseudohermaphroditism in congenital adrenogenital syndrome as an incidental intraoperative finding in a 68 year old patient]

• Immunocytochemical localization of NOVH protein and ultrastructural characteristics of NCI-H295R cells.

• Adrenal cortical carcinoma.

• Radiofrequency ablation used to treat select renal and adrenal tumors.

• [Adrenocortical carcinoma: prognostic factors for local recurrence and indications for reoperation. A report on a series of 22 patients]

• Abdominal wall metastasis after open resection of an adrenocortical carcinoma.

• [Clinical analysis of 17 patients with adrenal "incidentaloma"]

• Apoptosis control and proliferation marker in human normal and neoplastic adrenocortical tissues.

• Comparative genomic hybridization analysis of adrenocortical tumors.

1
UI - 11914473
AU - Sasano H; Suzuki T; Moriya T
TI - Discerning malignancy in resected adrenocortical neoplasms.
SO - Endocr Pathol 2001 Winter;12(4):397-406
AD - Department of Pathology, Tohoku University School of Medicine, 2-1 Seiryou-machi, Aoba-ku, Sendai, Japan 980-0872. hsasano@patholo2.med.tohoku.ac.jp
Differential diagnosis between adenoma and carcinoma in resected human adrenocortical neoplasms may be one of the most problematic and difficult areas of surgical pathology practice. This is especially true in cases of relatively small adrenocortical tumors not associated with obvious signs of malignancy such as necrosis and/or hemorrhage. In addition, the numbers of these small adrenocortical neoplasms are increasing owing to the widespread application of sophisticated computed tomography and/or magnetic resonance imaging scans. No single parameter can be effective in this differential diagnosis of resected adrenocortical tumor. Histopathologic evaluation using a multivariate scoring system is considered most effective in discerning malignancy and biologic behavior of resected adrenocortical neoplasms. Molecular and cellular findings of adrenocortical carcinoma have been inconsistent except for the increased cell proliferation associated with adrenocortical malignancy. Therefore, an assessment of neoplastic cell proliferation using immunostains of cell cycle-associated nuclear antigen such as Ki-67 is the only useful auxiliary method of evaluating malignancy in resected adrenocortical neoplasms at present.

2
UI - 11949624
AU - Erickson LA; Jin L; Sebo TJ; Lohse C; Pankratz VS; Kendrick ML; van
TI - Heerden JA; Thompson GB; Grant CS; Lloyd RV Pathologic features and expression of insulin-like growth factor-2 in adrenocortical neoplasms.
SO - Endocr Pathol 2001 Winter;12(4):429-35
AD - Department of Laboratory Medicine and Pathology, Mayo Clinic/Foundation, 200 First Street SW, Rochester, NY 55905, USA.
We analyzed a series of adrenocortical neoplasms to compare the clinicopathologic features and the expression of insulin-like growth factor-2 (IGF-2) in adrenocortical adenomas and carcinomas. IGF-2 is a growth factor commonly expressed in many tumors including adrenal cortical and medullary neoplasms. Formalin-fixed paraffin-embedded tissues from 64 adrenocortical adenomas and 67 adrenocortical carcinomas were analyzed. The carcinomas were histologically graded from 1 to 4 based on mitotic activity and necrosis. Tumor weight, size, and follow-up information were obtained by chart review. Expression of IGF-2 was detected by immunohistochemistry with the avidin-biotin-peroxidase complex method and a monoclonal antibody against IGF-2. Adrenocortical carcinomas were larger (mean: 13.1 cm, 787 g) than adenomas (mean: 4.2 cm, 52 g) (p < 0.001). Inpatients with adrenocortical carcinomas, high tumor grade (3 or 4) (p = 0.01) was associated with decreased survival. Expression of IGF-2 was higher in adrenocortical carcinomas than in adenomas (p < 0.001). These results show that tumor size and weight along with expression of IGF-2 protein are useful features to assist in distinguishing between adrenocortical adenomas and carcinomas, and that high tumor grade is a predictor of survival in adrenocortical carcinomas. However, single immunohistochemical markers such as IGF-2 or single histopathologic features cannot by themselves separate adrenocortical adenomas from carcinomas, and a combination of clinical, gross, and microscopic features are needed to establish the diagnosis in difficult cases.

3
UI - 11817708
AU - Grossrubatscher E; Vignati F; Possa M; Lohi P
TI - The natural history of incidentally discovered adrenocortical adenomas: a retrospective evaluation.
SO - J Endocrinol Invest 2001 Dec;24(11):846-55
AD - Endocrine Unit, Ospedale Niguarda Ca Granda, Milan, Italy.
Adrenal adenoma is the most frequent lesion among adrenal incidentalomas. The present retrospective study was undertaken to investigate medium-term evolution of supposed or ascertained adrenocortical adenomas in a group of 53 subjects (16 males and 37 females, aged 31-83 yr), with bilateral (no.=8) or monolateral (no.=45) incidentally discovered adrenal masses (size 10-50 mm, median 25 mm), who were followed-up for 6-78 months (median 24 months). Diagnosis of adenoma was based on size and morphovolumetric aspect of the lesion at computed tomography (CT), scintigraphic pattern using NP59 as a tracer, and it was histologically confirmed in 7 patients. After an extensive hormonal investigation including morning (no.=53) and midnight (no.=28) serum cortisol, plasma ACTH (no.=50), serum DHEAS (no.=51), daily urinary free cortisol excretion (no.=52), post-dexamethasone (1 mg) cortisol (no.=42) and ACTH stimulation test for 17-hydroxyprogesterone (17-OHP) response (no.=48) at the time of diagnosis, patients were periodically re-evaluated for hormonal function and radiological aspect of the lesion(s) by CT. Seven patients underwent surgery 6-42 months after incidentaloma demonstration, with histological diagnosis of adrenal adenoma. During follow-up an increase in the size of the lesion was demonstrated in 22 patients (41.5%); the increase was greater than 10 mm in 8 cases. In 3 patients with unilateral mass, a contralateral lesion appeared 10-52 months after first demonstration. Six patients (11.3%) showed reduction or disappearance of the lesions. On the basis of the hormonal evaluation 3 patients were considered to have subclinical Cushing's syndrome and 10 patients exhibited 17-OHP hyperresponse to ACTH test consistent with partial 21 -hydroxylase deficiency. A significant difference in the size of the lesions was observed between patients with or without 17-OHP hyperresponse to ACTH test (31.1 1.9 vs 24.1 +/- 1.2 mm; p<0.01). No significant changes in the hormonal parameters were observed in the patients, when retested. In conclusion, although none of the patients of the present series exhibited evolution to hypersecretion or to aberrant growth, in more than 40% of patients an increase in the size of the mass was observed, even after a long period of "quiescence". This suggests that a radiological re-evaluation of lesions should be periodically undertaken.

4
UI - 11827421
AU - Al Saad KO; Chan NH
TI - Test and teach. Surgically correctable hypertension. Conn's syndrome and spironolactone bodies.
SO - Pathology 2001 Nov;33(4):508-10
AD - Department of Pathology and Laboratory Medicine, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. khaledalsaad@hotmail.com

5
UI - 10874904
AU - Lang M; Sinn HP; Heilmann P; Klar E; Ziegler R; Seibel MJ
TI - [Female pseudohermaphroditism in congenital adrenogenital syndrome as an incidental intraoperative finding in a 68 year old patient]
SO - Dtsch Med Wochenschr 2000 May 26;125(21):660-4
AD - Abteilung Innere Medizin I (Endokrinologie und Stoffwechsel), Universitat Heidelberg.
HISTORY AND CLINICAL FINDINGS: A 68-year-old man of small stature, previously always healthy and with a grown-up daughter, was suspected of having carcinoma of the colon with metastasis to the right kidney. At laparotomy internal female genitalia with cancerous changes were unexpectedly discovered in the left adnexae. The colon carcinoma, the right adrenocortical tumour and left adnexae were resected. INVESTIGATIONS: Histological examination revealed adenocarcinoma of the colon, right adrenocortical adenoma and a Brenner tumour of the left female adnexae. Postoperative tests showed increased levels of 17-OH-progesterone (3192 ng/dl), 21-desoxycortisol (1856 ng/dl) and of adrostenedione (745 ng/dl), while the concentrations of 17-OH pregnenolone, testosterone and mineralocorticoids were within normal limits. Chromosome analysis demonstrated karyotype 46 XX. DIAGNOSIS, TREATMENT AND COURSE: As far as could be ascertained, this is the first documented case in the German-speaking region of female pseudohermaphroditism diagnosed in an elderly person with uncomplicated virilizing congenital adrenogrenital syndrome due to 21-hydroxylase deficiency (deletion of CYP21 gene). To avoid a cortisone deficiency crisis the patient was regularly given hydrocortisone and he quickly recovered. But he died 6 months later of sequelae of the carcinoma of the colon. CONCLUSION: An adrenogenital syndrome should be excluded in a case of bilateral adrenocortical tumour. As this is usually benign, conservative treatment should be attempted. This case demonstrates the necessity of thorough examination which could have given an early indication of the underlying condition.

6
UI - 11846094
AU - Thomopoulos GN; Kyurkchiev S; Perbal B
TI - Immunocytochemical localization of NOVH protein and ultrastructural characteristics of NCI-H295R cells.
SO - J Submicrosc Cytol Pathol 2001 Jul;33(3):251-60
AD - Aristotle University, School of Sciences, Department of Biology, Thessaloniki, Greece.
In this study we present biochemical and immunocytochemical results on NOVH protein secretion and localization in NCI-H295R cells, as well as results on the ultrastructural characteristics of NCI-H295R cells. NCI-H295R cells were characterized by small quantities of rough and smooth endoplasmic reticulum, many free ribosomes, large nuclei with prominent nucleoli, numerous elongated mitochondria, a few Golgi complexes, and a small number of lipid droplets. Large numbers of coated pits and coated vesicles were present, but no secretory granules or exocytotic profiles were seen. Best ultrastructural preservation of NCI-H295R cells was achieved when fixation was done directly on the culture dishes and the cells were detached by scraping. Our biochemical results showed that NCI-H295R cells secreted large amounts of NOVH protein. The immunocytochemical localization of NOVH protein showed that the protein was localized in the cytoplasm, the plasma membrane and the nuclear envelope. This localization pattern, along with the ultrastructural and biochemical findings raise interesting questions on the function(s) and the mode of secretion of NOVH protein.

7
UI - 12057116
AU - Boushey RP; Dackiw AP
TI - Adrenal cortical carcinoma.
SO - Curr Treat Options Oncol 2001 Aug;2(4):355-64
AD - Department of Surgical Oncology, Section of Endocrine Surgery, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Suite 3-130, Toronto, Ontario, Canada M5G 2M9.
Adrenal cortical carcinoma is a rare endocrine tumor, and complete surgical resection is the only potentially curative treatment. Accurate preoperative biochemical and radiographic evaluation of the patient who presents with an adrenal mass optimizes patient management and facilitates a complete margin-negative resection of the primary tumor--the most important prognostic variable for long-term survival. Response to mitotane or chemotherapy is modest in patients with advanced disease. It is hoped that an improved understanding of the molecular pathogenesis of this challenging tumor will lead to the development of novel treatment strategies.

8
UI - 12061373
AU - Zuboy J
TI - Radiofrequency ablation used to treat select renal and adrenal tumors.
SO - Curr Treat Options Oncol 2000 Jun;1(2):93-4

9
UI - 12094420
AU - Causeret S; Monneuse O; Mabrut JY; Berger N; Peix JL
TI - [Adrenocortical carcinoma: prognostic factors for local recurrence and indications for reoperation. A report on a series of 22 patients]
SO - Ann Chir 2002 May;127(5):370-7
AD - Service de chirurgie, hopital de l'Antiquaille, 69321 Lyon, France.
STUDY AIMS: The aim of this retrospective study was to identify prognostic factors on local recurrence in patients with adrenocortical carcinoma and to assess the effect of reoperations. METHODS: From 1985 to 2001, 22 patients were operated for adrenocortical carcinoma. We evaluated the correlation between actuarial survival without local recurrence and tumor staging, Weiss criteria, mitotic index, extensive resection and Op'DDD therapy by univariate analysis. Then we evaluated the effect of reoperations on survival. RESULTS: Local recurrence was observed in 7 patients and the 5-years actuarial survival without local recurrence was 50%. Tumor stage (I et II versus III et IV), Weiss criteria (< or = 6 criteria versus > 6) and mitotic index (< or = 20 mitoses/50 HPF versus > 20) affected survival without local recurrence. Extensive resection could reduce local recurrence rate. Op'DDD therapy was ineffective in prolonging survival without local recurrence. Four patients underwent repeat resections: 2 patients were still alive with disease free, 54 and 8 months after reoperations and 2 patients died, 19 and 25 months after reoperations. Three patients did not have repeat resection. They rapidly died within 8 months. CONCLUSION: Pathologic features (tumor staging and mitotic index) affected local recurrence prognostic. But extensive resection to adjacent organs could facilitate complete resection tumor and reduce the local recurrence rate. Complete repeat resection of local recurrence can improve survival. The disabling effects of Op'DDD were important and its efficacy was not clear.

10
UI - 11848245
AU - van Grevenstein WM; de Krijger RR; de Herder WW; Tilanus HW; Bonjer HJ
TI - Abdominal wall metastasis after open resection of an adrenocortical carcinoma.
SO - Eur J Surg 2001 Nov;167(11):871-3
AD - Department of Surgery, University Hospital Rotterdam, The Netherlands. vangrevenstein@hotmail.com

11
UI - 12016808
AU - Huang J; Zhou Z; Chao C
TI - [Clinical analysis of 17 patients with adrenal "incidentaloma"]
SO - Hunan Yi Ke Da Xue Xue Bao 1999;24(3):282-4
AD - Department of Endocrinology, Second Affiliated Hospital, Hunan Medical University, Changsha 410008.
This paper reports 17 cases of adrenal "incidentaloma", discovered by B-mode ultrasonography, computed tomography and/or magnetic resonance imaging scan and identified by operation and pathological examination. Seven of them were pathologically diagnosed as adrenocortical adenoma, 4 pheochromocytoma, 2 adrenal cyst, and 1 mixed cell adenoma, 1 leiomyoma, 1 adrenocortical carcinoma, and 1 gangliocytoma. Adrenal shows hormone-secreting function in 17 patients with adrenal "incidentaloma". The diagnosis and management of this disorder are discussed.

12
UI - 12085205
AU - Bernini GP; Moretti A; Viacava P; Bonadio AG; Iacconi P; Miccoli P;
TI - Salvetti A Apoptosis control and proliferation marker in human normal and neoplastic adrenocortical tissues.
SO - Br J Cancer 2002 May 20;86(10):1561-5
AD - Department of Internal Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy. g.bernini@med.unipi.it
We evaluated by immunohistochemistry the expression of the Bcl-2 and p53 proteins, as markers of apoptosis control, and of MIB-1, as a marker of cell proliferation, in a series of normal and neoplastic adrenocortical tissues. The specimens were 13 normal adrenals, 13 aldosterone-producing adenomas, 13 non-functioning adenomas and 16 carcinomas. Results were calculated as percentage of immunostained cells by using specific antibodies. No p53 protein was detected in any of the adrenocortical adenomas (functioning and non functioning) or normal adrenals, while p53 was overexpressed in 15 out of 16 carcinomas. In particular, 10 adrenal cancer specimens (62.5%) showed strong staining in a high percentage (range 10-50%) of the malignant cells. The percentage of Bcl-2 positive cells was higher (P<0.05 or less) in non-functioning adenomas (8.1+/-1.9%) and in carcinomas (14.9+/-5.6%) than in normals (2.9+/-0.9%) and aldosterone-producing adenomas (5.3+/-1.3%) since four specimens of the non-functioning adenomas-group (30.7%) and six of the carcinomas-group (37.5%) showed over 10% positivity (cut-off for normal values, set at 90th percentile of our controls). MIB-1 positivity was 0.50+/-0.36% in normals, 0.54+/-0.08% in non-functioning adenomas and 0.54+/-0.08% in aldosterone-producing adenomas. MIB-1 was expressed in all carcinomas with values (13.7+/-3.1%) significantly (P<0.0006) higher than in the other groups. In conclusion, the present data indicate that the apoptosis control and proliferation activity evaluated by the p53 and MIB-1 proteins are impaired in adrenal carcinomas but preserved in adenomas, independently of their functional status. Therefore, these immunohistochemical markers, overexpressed in carcinomas only, may be useful in the diagnosis of malignancy in adrenocortical tumours. Whether Bcl-2 positivity found in some carcinomas and non-functioning adenomas may constitute, in the latter, a negative prognostic marker is still unknown. comCopyright 2002 Cancer Research UK

13
UI - 12107267
AU - Sidhu S; Marsh DJ; Theodosopoulos G; Philips J; Bambach CP; Campbell P;
TI - Magarey CJ; Russell CF; Schulte KM; Roher HD; Delbridge L; Robinson BG Comparative genomic hybridization analysis of adrenocortical tumors.
SO - J Clin Endocrinol Metab 2002 Jul;87(7):3467-74
AD - Cancer Genetics, Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, New South Wales 2065, Australia.
Comparative genomic hybridization (CGH) is a molecular cytogenetic technique that allows the entire genome of a tumor to be surveyed for gains and losses of DNA copy sequences. A limited number of studies reporting the use of this technique in adult adrenocortical tumors have yielded conflicting results. In this study we performed CGH analysis on 13 malignant, 18 benign, and 1 tumor of indeterminate malignant potential with the aim of identifying genetic loci consistently implicated in the development and progression of adrenocortical tumors. Tissue samples from 32 patients with histologically proven adrenocortical tumors were available for CGH analysis. CGH changes were seen in all cancers, 11 of 18 (61%) adenomas, and the 1 tumor of indeterminate malignant potential. Of the adrenal cancers, the most common gains were seen on chromosomes 5 (46%), 12 (38%), 19 (31%), and 4 (31%). Losses were most frequently seen at 1p (62%), 17p (54%), 22 (38%), 2q (31%), and 11q (31%). Of the benign adenomas, the most common change was gain of 4q (22%). Mann-Whitney analysis showed a highly significant difference between the cancer group (mean changes, 7.6) and the adenoma group (mean changes, 1.1) for the number of observed CGH changes (P < 0.01). Logistic regression analysis showed that the number of CGH changes was highly predictive of tumor type (P < 0.01). This study has identified several chromosomal loci implicated in adrenocortical tumorigenesis. Activation of a protooncogene(s) on chromosome 4 may be an early event, with progression from adenoma to carcinoma involving activation of oncogenes on chromosomes 5 and 12 and inactivation of tumor suppressor genes on chromosome arms 1p and 17p.

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