title: Pathologic features and expression of insulin-like growth factor-2 in adrenocortical neoplasms.
abstract: 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.
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic/Foundation, 200 First Street SW, Rochester, NY 55905, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Erickson
authors.forename: L
authors.initials: L
authors.lastname: Jin
authors.forename: T J
authors.initials: TJ
authors.lastname: Sebo
authors.forename: C
authors.initials: C
authors.lastname: Lohse
authors.forename: V S
authors.initials: VS
authors.lastname: Pankratz
authors.forename: M L
authors.initials: ML
authors.lastname: Kendrick
authors.forename: J A
authors.initials: JA
authors.lastname: van Heerden
authors.forename: G B
authors.initials: GB
authors.lastname: Thompson
authors.forename: C S
authors.initials: CS
authors.lastname: Grant
authors.forename: R V
authors.initials: RV
authors.lastname: Lloyd
mesh_terms: D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000378:metabolism* / Q000401:mortality / Q000473:pathology*; D018246:Adrenocortical Adenoma / Q000378:metabolism* / Q000401:mortality / Q000473:pathology*; D018268:Adrenocortical Carcinoma / Q000378:metabolism* / Q000401:mortality / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D007335:Insulin-Like Growth Factor II / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D008938:Mitosis; D009336:Necrosis; D016019:Survival Analysis; D015996:Survival Rate
chemical_list: D007335:Insulin-Like Growth Factor II