title: Clinicopathological features, biochemical and molecular markers in 5 patients with adrenocortical carcinoma.
abstract: Adrenocortical carcinoma (ACC) is a very rare malignant tumor with poor prognosis. To gain insight into the pathogenic significance of ACC, we studied clinicopathological features and gene expression profile in ACC. We analyzed five ACC cases (two men and three women) with the median age of 45-year-old who underwent adrenalectomy at our institute. Endocrine studies revealed that two cases had subclinical Cushing's syndrome (SCS) and one with concomitant estrogen-secreting tumor, while the rest of three cases had non-functioning tumors. Analysis of urinary steroids profile by gas chromatography/mass spectrometry showed increased metabolites of corticosteroid precursors, such as 17-OH pregnenolone, 17-OH progesterone, dehydroepiandorosterone (DHEA), and 11-deoxycortisol in all five cases. The pathological diagnosis of ACC was based on Weiss's criteria with its score ≥ 3. The mean size of the resected tumors was 87 mm and Ki67/MIB1 labeling index, a proliferative marker, was 3-27%. Immunohistochemical analysis revealed a disorganized expression of several steroidogenic enzymes, such as 3β-hydroxysteroid dehydrogenase, 17α-hydroxylase, and DHEA-sulfotransferase. Among several genes determined by RT-PCR, insulin-like growth factor (IGF)-II mRNA was consistently and abundantly expressed in all 5 tumor tissues. Postoperatively, two cases with SCS developed local recurrence and liver metastasis. The present study suggests that the disorganized expression of steroidogenic enzymes and the overexpression of IGF-II by the tumor are hallmarks of ACC, which could be used as biochemical and molecular markers for ACC.
authors.affiliation: Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Kouyama
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Hiraishi
authors.forename: Toru
authors.initials: T
authors.lastname: Sugiyama
authors.forename: Hajime
authors.initials: H
authors.lastname: Izumiyama
authors.forename: Takanobu
authors.initials: T
authors.lastname: Yoshimoto
authors.forename: Takumi
authors.initials: T
authors.lastname: Akashi
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
authors.forename: Keiko
authors.initials: K
authors.lastname: Homma
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Shibata
authors.forename: Yukio
authors.initials: Y
authors.lastname: Hirata
mesh_terms: D006907:17-alpha-Hydroxypregnenolone / Q000031:analogs & derivatives* / Q000378:metabolism / Q000652:urine; D019326:17-alpha-Hydroxyprogesterone / Q000378:metabolism* / Q000652:urine; D000306:Adrenal Cortex Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery / Q000652:urine; D018268:Adrenocortical Carcinoma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery / Q000652:urine; D000328:Adult; D003350:Cortodoxone / Q000378:metabolism* / Q000652:urine; D003687:Dehydroepiandrosterone / Q000378:metabolism* / Q000652:urine; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D020869:Gene Expression Profiling; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D012334:RNA, Neoplasm / Q000737:chemistry / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: C495856:7-hydroxypregnenolone; D012334:RNA, Neoplasm; D006907:17-alpha-Hydroxypregnenolone; D003687:Dehydroepiandrosterone; D019326:17-alpha-Hydroxyprogesterone; D003350:Cortodoxone