title: Adrenocortical carcinoma: clinical, morphologic, and molecular characterization.
abstract: OBJECTIVE
  To define multimolecular phenotypes of adrenocortical carcinoma (ACC) and to correlate outcome with morphologic and molecular parameters.
  
  
  METHODS
  Clinical data were analyzed for 124 patients, histopathologic slides for 67 primary tumors, and tissue specimens for 74 patients (38 primary and 36 metastatic tumors) with ACC and for 38 normal adrenal tissue samples. Molecular expression profiles were investigated by immunohistochemistry. The prognostic significance of 12 gross and histologic parameters in 67 primary ACCs was evaluated. Morphologic and protein expression patterns were correlated with disease-specific survival (DSS). Univariate influence of prognostic factors on DSS was analyzed by log-rank test and multivariate analysis by Cox regression.
  
  
  RESULTS
  The median follow-up period was 4.7 years. Significant predictors of DSS included distant metastasis at time of initial presentation; venous, capsular, and adjacent organ invasion; tumor necrosis, mitotic rate, atypical mitosis, and mdm-2 overexpression. Five-year DSS by number (one to six) of adverse histologic parameters was as follows: one to two, 84%; three to four, 37%; more than four, 9% (P =.005). The phenotype Ki-67(-)p53(-)mdm-2(+)cyclinD1(-)Bcl-2(-)p21(-)p27(+) was observed in 83% of normal and 3% of malignant adrenal tissue (P =.01). Molecular phenotypic expression was more heterogeneous in malignant than in normal (10 v five phenotypes) adrenal tissue.
  
  
  CONCLUSIONS
  Meticulous morphologic evaluation, mitotic count, and tumor stage are essential in determining prognosis for patients with ACC. Multimolecular phenotyping demonstrates that the molecular complexity and heterogeneity of these neoplasms are such that targeted therapy needs to be patient specific.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Ghossein
authors.forename: Axel
authors.initials: A
authors.lastname: Hoos
authors.forename: Aviram
authors.initials: A
authors.lastname: Nissan
authors.forename: David
authors.initials: D
authors.lastname: Marshall
authors.forename: Maria
authors.initials: M
authors.lastname: Dudas
authors.forename: Carlos
authors.initials: C
authors.lastname: Cordon-Cardo
authors.forename: David P
authors.initials: DP
authors.lastname: Jaques
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
mesh_terms: D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000235:genetics / Q000473:pathology*; D018268:Adrenocortical Carcinoma / Q000235:genetics / Q000473:pathology*; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008938:Mitosis; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009687:Nuclear Proteins; D010641:Phenotype; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000096:biosynthesis; D051736:Proto-Oncogene Proteins c-mdm2; D012189:Retrospective Studies
chemical_list: D009687:Nuclear Proteins; D011518:Proto-Oncogene Proteins; C497206:MDM2 protein, human; D051736:Proto-Oncogene Proteins c-mdm2