Skip to main content
PMC home page
The American Journal of Pathology logoLink to The American Journal of Pathology
. 1986 Feb;122(2):343–352.

Adrenocortical carcinoma. An immunohistochemical comparison with renal cell carcinoma.

M R Wick, D L Cherwitz, R C McGlennen, L P Dehner
PMCID: PMC1888093  PMID: 2418689

Abstract

The diagnosis of adrenocortical carcinoma (ACC) is often difficult, because this tumor may present with direct extension into adjacent renal parenchyma or with metastatic disease. Renal cell carcinoma and other histologically similar tumors are potentially confused with ACC by conventional light microscopy, and their separation from the latter is often impossible without the aid of additional studies. Furthermore, the distinction between adrenal cortical adenoma and ACC may also be problematic. Because of these factors, the authors studied 10 cases each of ACC, adrenocortical adenoma, and renal cell carcinoma (RCC) immunohistochemically, in an attempt to develop objective parameters which may aid in this differential diagnostic dilemma. Nontrypsinized, formalin-fixed, paraffin-embedded specimens were used in all cases, and tissue from the adrenocortical tumors was also studied for intermediate filament content after protease digestion. All 20 nontrypsinized adrenocortical neoplasms were positive for vimentin, but not for cytokeratin, epithelial membrane antigen, or blood group isoantigens. Conversely, each of 10 cases of RCC expressed epithelial membrane antigen, cytokeratin, and blood group isoantigens, but none was immunoreactive for vimentin. Two adrenocortical carcinomas and three adenomas manifested cytokeratin positivity after trypsin digestion. There were no significant differences between the immunostaining profiles of ACC and adrenocortical adenoma, which suggest that this distinction must still rely upon clinical and morphologic criteria.

Full text

PDF
343

Images in this article

346Figure 1
on p.346
347Figure 2
on p.347
347Figure 3
on p.347
348Figure 4
on p.348
349Figure 5
on p.349
349Figure 6
on p.349
350Figure 7
on p.350

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Battifora H. Recent progress in the immunohistochemistry of solid tumors. Semin Diagn Pathol. 1984 Nov;1(4):251–271. [PubMed] [Google Scholar]
  2. Boven E., Vermorken J. B., van Slooten H., Pinedo H. M. Complete response of metastasized adrenal cortical carcinoma with o,p'-DDD. Case report and literature review. Cancer. 1984 Jan 1;53(1):26–29. doi: 10.1002/1097-0142(19840101)53:1<26::aid-cncr2820530107>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
  3. Didolkar M. S., Bescher R. A., Elias E. G., Moore R. H. Natural history of adrenal cortical carcinoma: a clinicopathologic study of 42 patients. Cancer. 1981 May 1;47(9):2153–2161. doi: 10.1002/1097-0142(19810501)47:9<2153::aid-cncr2820470908>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  4. Foucar E., Dehner L. P. Renal cell carcinoma occurring with contralateral adrenal metastasis: a clinical and pathological trap. Arch Surg. 1979 Aug;114(8):959–963. doi: 10.1001/archsurg.1979.01370320091019. [DOI] [PubMed] [Google Scholar]
  5. Fuhrman S. A., Lasky L. C., Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982 Oct;6(7):655–663. doi: 10.1097/00000478-198210000-00007. [DOI] [PubMed] [Google Scholar]
  6. Gown A. M., Vogel A. M. Monoclonal antibodies to intermediate filament proteins of human cells: unique and cross-reacting antibodies. J Cell Biol. 1982 Nov;95(2 Pt 1):414–424. doi: 10.1083/jcb.95.2.414. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Herman C. J., Moesker O., Kant A., Huysmans A., Vooijs G. P., Ramaekers F. C. Is renal cell (Grawitz) tumor a carcinosarcoma? Evidence from analysis of intermediate filament types. Virchows Arch B Cell Pathol Incl Mol Pathol. 1983;44(1):73–83. doi: 10.1007/BF02890161. [DOI] [PubMed] [Google Scholar]
  8. Hogan T. F., Gilchrist K. W., Westring D. W., Citrin D. L. A clinical and pathological study of adrenocortical carcinoma: therapeutic implications. Cancer. 1980 Jun 1;45(11):2880–2883. doi: 10.1002/1097-0142(19800601)45:11<2880::aid-cncr2820451127>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  9. Holden C. A., Shaw M., McKee P. H., Sanderson A. R., MacDonald D. M. Loss of membrane B2 microglobulin in eccrine porocarcinoma. Its association with the histopathologic and clinical criteria of malignancy. Arch Dermatol. 1984 Jun;120(6):732–735. [PubMed] [Google Scholar]
  10. Hough A. J., Hollifield J. W., Page D. L., Hartmann W. H. Prognostic factors in adrenal cortical tumors. A mathematical analysis of clinical and morphologic data. Am J Clin Pathol. 1979 Sep;72(3):390–399. doi: 10.1093/ajcp/72.3.390. [DOI] [PubMed] [Google Scholar]
  11. Hsu S. M., Raine L., Fanger H. Use of avidin-biotin-peroxidase complex (ABC) in immunoperoxidase techniques: a comparison between ABC and unlabeled antibody (PAP) procedures. J Histochem Cytochem. 1981 Apr;29(4):577–580. doi: 10.1177/29.4.6166661. [DOI] [PubMed] [Google Scholar]
  12. King D. R., Lack E. E. Adrenal cortical carcinoma: a clinical and pathologic study of 49 cases. Cancer. 1979 Jul;44(1):239–244. doi: 10.1002/1097-0142(197907)44:1<239::aid-cncr2820440139>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  13. Lehtonen E., Lehto V. P., Paasivuo R., Virtanen I. Parietal and visceral endoderm differ in their expression of intermediate filaments. EMBO J. 1983;2(7):1023–1028. doi: 10.1002/j.1460-2075.1983.tb01540.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Limas C., Lange P. Altered reactivity for A, B, H antigens in transitional cell carcinomas of the urinary bladder. A study of the mechanisms involved. Cancer. 1980 Sep 15;46(6):1366–1373. doi: 10.1002/1097-0142(19800915)46:6<1366::aid-cncr2820460613>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  15. Miettinen M., Lehto V. P., Virtanen I. Immunofluorescence microscopic evaluation of the intermediate filament expression of the adrenal cortex and medulla and their tumors. Am J Pathol. 1985 Mar;118(3):360–366. [PMC free article] [PubMed] [Google Scholar]
  16. Miettinen M., Lehto V. P., Virtanen I. Presence of fibroblast-type intermediate filaments (vimentin) and absence of neurofilaments in pigmented nevi and malignant melanomas. J Cutan Pathol. 1983 Jun;10(3):188–192. doi: 10.1111/j.1600-0560.1983.tb00325.x. [DOI] [PubMed] [Google Scholar]
  17. Nagle R. B., McDaniel K. M., Clark V. A., Payne C. M. The use of antikeratin antibodies in the diagnosis of human neoplasms. Am J Clin Pathol. 1983 Apr;79(4):458–466. doi: 10.1093/ajcp/79.4.458. [DOI] [PubMed] [Google Scholar]
  18. Said J. W., Nash G., Tepper G., Banks-Schlegel S. Keratin proteins and carcinoembryonic antigen in lung carcinoma: an immunoperoxidase study of fifty-four cases, with ultrastructural correlations. Hum Pathol. 1983 Jan;14(1):70–76. doi: 10.1016/s0046-8177(83)80048-3. [DOI] [PubMed] [Google Scholar]
  19. Schteingart D. E., Oberman H. A., Friedman B. A., Conn J. W. Adrenal cortical neoplasms producing cushing's syndrome. A clinicopathologic study. Cancer. 1968 Nov;22(5):1005–1013. doi: 10.1002/1097-0142(196811)22:5<1005::aid-cncr2820220516>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  20. Sheibani K., Tubbs R. R. Enzyme immunohistochemistry: technical aspects. Semin Diagn Pathol. 1984 Nov;1(4):235–250. [PubMed] [Google Scholar]
  21. Silva E. G., Mackay B., Samaan N. A., Hickey R. C. Adrenocortical carcinomas: an ultrastructural study of 22 cases. Ultrastruct Pathol. 1982 Jan-Mar;3(1):1–7. doi: 10.3109/01913128209016619. [DOI] [PubMed] [Google Scholar]
  22. Sloane J. P., Ormerod M. G. Distribution of epithelial membrane antigen in normal and neoplastic tissues and it value in diagnostic tumor pathology. Cancer. 1981 Apr 1;47(7):1786–1795. doi: 10.1002/1097-0142(19810401)47:7<1786::aid-cncr2820470711>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  23. Springall D. R., Gu J., Cocchia D., Michetti F., Levene A., Levene M. M., Marangos P. J., Bloom S. R., Polak J. M. The value of S-100 immunostaining as a diagnostic tool in human malignant melanomas. A comparative study using S-100 and neuron-specific enolase antibodies. Virchows Arch A Pathol Anat Histopathol. 1983;400(3):331–343. doi: 10.1007/BF00612194. [DOI] [PubMed] [Google Scholar]
  24. Sternberger L. A., Hardy P. H., Jr, Cuculis J. J., Meyer H. G. The unlabeled antibody enzyme method of immunohistochemistry: preparation and properties of soluble antigen-antibody complex (horseradish peroxidase-antihorseradish peroxidase) and its use in identification of spirochetes. J Histochem Cytochem. 1970 May;18(5):315–333. doi: 10.1177/18.5.315. [DOI] [PubMed] [Google Scholar]
  25. Sun T. T., Shih C., Green H. Keratin cytoskeletons in epithelial cells of internal organs. Proc Natl Acad Sci U S A. 1979 Jun;76(6):2813–2817. doi: 10.1073/pnas.76.6.2813. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Tang C. K., Gray G. F. Adrenocortical neoplasms. Prognosis and morphology. Urology. 1975 May;5(5):691–695. doi: 10.1016/0090-4295(75)90135-1. [DOI] [PubMed] [Google Scholar]
  27. Thung S. N., Gerber M. A., Sarno E., Popper H. Distribution of five antigens in hepatocellular carcinoma. Lab Invest. 1979 Aug;41(2):101–105. [PubMed] [Google Scholar]
  28. Weiss L. M. Comparative histologic study of 43 metastasizing and nonmetastasizing adrenocortical tumors. Am J Surg Pathol. 1984 Mar;8(3):163–169. doi: 10.1097/00000478-198403000-00001. [DOI] [PubMed] [Google Scholar]
  29. Woodcock-Mitchell J., Eichner R., Nelson W. G., Sun T. T. Immunolocalization of keratin polypeptides in human epidermis using monoclonal antibodies. J Cell Biol. 1982 Nov;95(2 Pt 1):580–588. doi: 10.1083/jcb.95.2.580. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. van Slooten H., Schaberg A., Smeenk D., Moolenaar A. J. Morphologic characteristics of benign and malignant adrenocortical tumors. Cancer. 1985 Feb 15;55(4):766–773. doi: 10.1002/1097-0142(19850215)55:4<766::aid-cncr2820550414>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]

Articles from The American Journal of Pathology are provided here courtesy of American Society for Investigative Pathology

RESOURCES