Oncocytic adrenocortical neoplasms: a report of seven cases and review of the literature.

Oncocytic neoplasms of the adrenal gland are rare. We describe the clinicopathologic and immunohistochemical findings of seven oncocytic adrenocortical neoplasms, five oncocytomas, and two oncocytic neoplasms of uncertain malignant potential. Three tumors were studied using electron microscopy. These neoplasms occurred in five women and two men (median age, 55 years) with no clinical evidence that the neoplasms were functional. The size of the neoplasms varied from 5.0 cm to 13.5 cm. Histologically, each neoplasm was composed exclusively of oncocytes. The oncocytomas had very low or absent mitotic activity and no evidence of necrosis. The two oncocytic neoplasms of uncertain malignant potential had increased mitotic activity and necrosis but no evidence of invasion or metastases. Nuclear atypia, either focal or generalized, was found in all neoplasms. Immunohistochemical studies performed using fixed, paraffin-embedded sections showed strong reactivity with the mitochondrial antibody mES-13 in all neoplasms. Four of five oncocytomas and one oncocytic neoplasm of uncertain malignant potential expressed keratin, predominantly keratin 18, as shown using the CAM 5.2 and AE3 antibodies. Two neuroendocrine-associated markers, neuron specific enolase and synaptophysin, were positive in seven and five neoplasms, respectively. However, all neoplasms were negative for the other neuroendocrine markers tested, including chromogranin A, tyrosine hydroxylase, and dopamine beta-hydroxylase, as well as for epithelial membrane antigen, S100, and p53. Using the MIB-1 (Ki-67) antibody, proliferative activity was increased in both oncocytic neoplasms of uncertain malignant potential. All six patients with available clinical follow-up data are alive without evidence disease, although the follow-up interval is relatively short (< 2 years) for the two patients with oncocytic neoplasms of uncertain malignant potential. We conclude that oncocytic adrenocortical neoplasms are nonfunctional tumors that can become large before they are detected by radiologic studies. The majority of neoplasms are benign and should not be misdiagnosed as carcinoma.

[1]  M. Vasef,et al.  Cyclin D1 immunohistochemical staining is useful in distinguishing mantle cell lymphoma from other low-grade B-cell neoplasms in bone marrow. , 1997, American journal of clinical pathology.

[2]  R. Alsabeh,et al.  Immunophenotype of Reed-Sternberg and Hodgkin's cells in sequential biopsy specimens of Hodgkin's disease: a paraffin-section immunohistochemical study using the heat-induced epitope retrieval method. , 1997, American journal of clinical pathology.

[3]  M. Merino,et al.  Adrenocortical neoplasms: role of prognostic markers MIB-1, P53, and RB. , 1997, The American journal of surgical pathology.

[4]  G. D. Haselhuhn,et al.  Adrenocortical oncocytoma: two case reports and review of literature. , 1997, Urology.

[5]  L. Schwartz,et al.  Case report. Adrenocortical oncocytoma: CT and MRI findings. , 1996, Journal of computer assisted tomography.

[6]  R. Alsabeh,et al.  Adrenal cortical tumors clinically mimicking pheochromocytoma. , 1995, American journal of clinical pathology.

[7]  P. Komminoth,et al.  Overlapping expression of immunohistochemical markers and synaptophysin mRNA in pheochromocytomas and adrenocortical carcinomas. Implications for the differential diagnosis of adrenal gland tumors. , 1995, Laboratory investigation; a journal of technical methods and pathology.

[8]  J. Goldblum,et al.  Immunohistochemical assessment of proliferative activity in adrenocortical neoplasms. , 1993, Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc.

[9]  W. Lakey,et al.  Heterotopic adrenocortical oncocytoma a case report with light and electron microscopic studies , 1992, Cancer.

[10]  T. Sano,et al.  Adrenocortical Oncocytoma: A True Nonfunctioning Adrenocortical Tumor , 1991, The American journal of surgical pathology.

[11]  M. Gaffey,et al.  Immunocytochemical characterization of a monoclonal antibody directed against mitochondria reactive in paraffin-embedded sections. , 1991, Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc.

[12]  V. Reuter,et al.  Oncocytic adrenal cortical adenoma. , 1991, Ultrastructural pathology.

[13]  S. Steinberg,et al.  Histopathology of benign versus malignant sympathoadrenal paragangliomas: clinicopathologic study of 120 cases including unusual histologic features. , 1990, Human pathology.

[14]  L. Medeiros,et al.  Cellular DNA Profiles of Benign and Malignant Adrenocortical Tumors , 1990, The American journal of surgical pathology.

[15]  L. Medeiros,et al.  Pathologic Features of Prognostic Significance in Adrenocortical Carcinoma , 1989, The American journal of surgical pathology.

[16]  R. Moll,et al.  Chromophobe cell renal carcinoma and its variants—a report on 32 cases , 1988, The Journal of pathology.

[17]  K. Nilsson,et al.  Expression of gamma-subunit of enolase, neuron-specific enolase, in human non-neuroendocrine tumors and derived cell lines. , 1986, Laboratory investigation; a journal of technical methods and pathology.

[18]  I. Taylor,et al.  Application of DNA flow cytometry to paraffin-embedded archival material for the study of aneuploidy and its clinical significance. , 1985, Cytometry.

[19]  R. Lloyd,et al.  Distribution of chromogranin and S100 protein in normal and abnormal adrenal medullary tissues. , 1985, Archives of pathology & laboratory medicine.

[20]  L. Medeiros,et al.  Adrenal pheochromocytoma: a clinicopathologic review of 60 cases. , 1985, Human pathology.

[21]  L. Weiss Comparative histologic study of 43 metastasizing and nonmetastasizing adrenocortical tumors , 1984, The American journal of surgical pathology.

[22]  L. Medeiros,et al.  New developments in the pathologic diagnosis of adrenal cortical neoplasms. A review. , 1992, American journal of clinical pathology.

[23]  D. Evans,et al.  Oncocytic adrenal cortical carcinoma. , 1991, Ultrastructural pathology.