Discerning malignancy in human adrenocortical neoplasms: utility of DNA flow cytometry and immunohistochemistry

In order to evaluate more objective laboratory methods that may help practicing pathologists to discern malignancy in human adrenocortical neoplasms, we have examined cellular DNA content by flow cytometry and immunohistochemical distribution of c-myc, vimentin, proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR) in 15 cases of human adrenocortical neoplasms (nine carcinomas and six adenomas). All of these examinations were performed on routinely processed surgical pathology specimens. All carcinoma cases met Weiss's histologic criteria. Seven of eight adrenocortical carcinomas demonstrated aneuploid DNA content, while all adenomas were diploid by flow cytometry. c-myc oncoprotein was observed both in cytoplasms and nuclei in all carcinomas but only in nuclei in adenomas. Vimentin was present in all carcinoma cases examined but was also observed in three of six cases of adenoma. There were no clinical or histologic differences between vimentin-positive and vimentin-negative adenomas. Immunoreactivity of PCNA and EGFR was observed in all the cases examined. There were no significant differences in distribution or patterns of immunoreactivity between adrenocortical carcinoma and adenoma. Therefore, we conclude that only DNA ploidy examined by flow cytometry and immunolocalization patterns of c-myc oncoprotein expression have any practical value in the pathologic evaluation of adrenocortical neoplasms. Careful morphologic and/or clinical studies are still considered to be the best available methods in discerning malignancy in resected human adrenocortical neoplasms.