title: Correlation between selected angiogenic markers and prognosis in pediatric adrenocortical tumors: Angiogenic markers and prognosis in pediatric ACTs.
abstract: OBJECTIVE
  Pediatric adrenocortical tumor (ACT) remains a challenging disease. Tumor weight and disease stage are still the most used indicators to prognosis and guidance of clinical decisions. Histology has not added meaningful data for risk stratification and management. ACT is metabolically active, highly vascularized, locally invasive and has the propensity to produce distant metastasis. Our objective was to correlate the expression of vascular endothelial growth factor (VEGF) and intratumoral microvessel density (MVD) with clinical and prognostic aspects in pediatric ACT.
  
  
  METHODS
  In 27 tumors, immunohistochemical expression of VEGF, CD105 (endoglin) and CD34 was analyzed. MVD was determined by CD34 and CD105 antibodies. MVD and VEGF expression was correlated with clinical characteristics and outcome. Normal pediatric glands were used as controls.
  
  
  RESULTS
  Endoglin MVD was significantly higher and CD34 MVD was significantly lower in ACT than control. The VEGF expression did not differ between groups. Cytoplasmic staining for endoglin was correlated with hypertension in ACT. Endoglin MVD greater than 1 mv/field, CD34 MVD less than 32 mv/field and VEGF expression levels above 4.8% were associated with clinical and biological indicators of poor prognosis.
  
  
  CONCLUSIONS
  Endoglin and CD34 MVD values are potential histological markers to refine the histologic classification of pediatric ACT.
authors.affiliation: Pediatric Surgery, Department of Surgery, Universidade Federal de São Paulo/ Escola Paulista de Medicina - UNIFESP/EPM, Rua Coronel Lisboa, 687, São Paulo-SP, 04020-041, Brasil. Electronic address: andrebradleymd@gmail.com.
authors.forename: André Ivan Bradley dos Santos
authors.initials: AI
authors.lastname: Dias
authors.affiliation: Pediatric Surgery, Department of Surgery, Universidade Federal de São Paulo/ Escola Paulista de Medicina - UNIFESP/EPM, Rua Coronel Lisboa, 687, São Paulo-SP, 04020-041, Brasil.
authors.forename: Camila Girardi
authors.initials: CG
authors.lastname: Fachin
authors.affiliation: Department of Pathology, Universidade Federal de São Paulo/ Escola Paulista de Medicina - UNIFESP/EPM, Rua Botucatu, 740, São Paulo-SP, 04023-062, Brasil.
authors.forename: Lucimar Retto Silva
authors.initials: LR
authors.lastname: Avó
authors.affiliation: Pediatric Surgery, Department of Surgery, Universidade Federal de São Paulo/ Escola Paulista de Medicina - UNIFESP/EPM, Rua Coronel Lisboa, 687, São Paulo-SP, 04020-041, Brasil.
authors.forename: Caio Vinicius Gonçalves
authors.initials: CV
authors.lastname: Frazão
authors.affiliation: Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo/ Escola Paulista de Medicina - UNIFESP/EPM, Rua Botucatu, 743, São Paulo, SP, 04023-062, Brasil.
authors.forename: Eliana Maria Monteiro
authors.initials: EM
authors.lastname: Caran
authors.affiliation: Pediatric Surgery, Department of Surgery, Universidade Federal de São Paulo/ Escola Paulista de Medicina - UNIFESP/EPM, Rua Coronel Lisboa, 687, São Paulo-SP, 04020-041, Brasil.
authors.forename: Sérgio Tomaz
authors.initials: ST
authors.lastname: Schettini
authors.affiliation: Department of Pathology, Universidade Federal de São Paulo/ Escola Paulista de Medicina - UNIFESP/EPM, Rua Botucatu, 740, São Paulo-SP, 04023-062, Brasil.
authors.forename: Maria Teresa Seixas
authors.initials: MT
authors.lastname: Alves
authors.affiliation: St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678.
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
authors.affiliation: Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo/ Escola Paulista de Medicina - UNIFESP/EPM, Rua Botucatu, 743, São Paulo, SP, 04023-062, Brasil.
authors.forename: Simone de Campos Vieira
authors.initials: Sde C
authors.lastname: Abib
mesh_terms: D000293:Adolescent; D000302:Adrenal Cortex / Q000098:blood supply* / Q000378:metabolism; D000306:Adrenal Cortex Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D018268:Adrenocortical Carcinoma / Q000098:blood supply / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D015703:Antigens, CD / Q000378:metabolism; D018952:Antigens, CD34 / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D000071063:Endoglin; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D055806:Microvessels / Q000378:metabolism / Q000473:pathology*; D009389:Neovascularization, Pathologic / Q000378:metabolism*; D011379:Prognosis; D011956:Receptors, Cell Surface / Q000378:metabolism; D012189:Retrospective Studies; D016019:Survival Analysis; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D015703:Antigens, CD; D018952:Antigens, CD34; D014408:Biomarkers, Tumor; C064206:ENG protein, human; D000071063:Endoglin; D011956:Receptors, Cell Surface; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A
keywords: Adrenocortical tumor; Angiogenesis and children; Immunohistochemistry; Prognosis