DNA analysis and clinical outcome in pediatric adrenal cortical tumors

Adrenal cortical neoplasms are uncommon and it is often difficult to separate benign tumors from those that are malignant. Histology does not provide a reliable guide, particularly in pediatric cases. It has been suggested that analysis of nuclear DNA content may complement conventional histopathologic methods in the diagnosis of malignancy. Six previously reported adrenal cortical tumors from children aged 6 mths to 6 yrs were analysed using a CAS 200 image analysis system which provided DNA histograms on each of the cases. In 5 cases a significant proportion of the tumors showed aneuploidy and in only one case did most of the tumor cells show a diploid pattern. All 6 cases were treated with surgery alone with long term survival and follow up of 2-15 yrs except in one child with a histologically benign aneuploid tumor who died post-operatively from measles pneumonia. No correlation between histological appearance, outcome and ploidy was seen. The aneuploid tumors included those classified by current histological methods as benign (1), indeterminant (2) and malignant (2). The one diploid tumor seen was a large tumor of indeterminant malignancy that did not recur. Although the series is quite small these observations suggest that abnormalities of DNA content may not provide an objective measure of the malignant potential of adrenal cortical tumors in children.