Orhan Diclehan, Kale Gülsev, Cağlar Melda, Göğüş Safiye, Karaağaoğlu Ergun
Division of Pediatric Pathology, Hacettepe University Faculty of Medicine, Ihsan Doğramaci Children's Hospital, 06100, Sihhiye, Ankara, Turkey.
Virchows Arch. 2006 May;448(5):591-6. doi: 10.1007/s00428-006-0152-2. Epub 2006 Feb 18.
Adrenocortical tumors in the pediatric population are rare. Classification of these tumors as adenomas or carcinomas using histological criteria is often difficult. Immunohistochemical expressions of proliferative markers are currently under investigation for utilization in the differential diagnosis and prediction of clinical outcomes. The value of histone proteins as prognostic markers in adrenocortical tumors has not yet been elucidated. We evaluated the histological features, immunohistochemical staining of Ki 67, and in situ hybridization for histone mRNA in 30 pediatric adrenocortical tumors. We investigated the relationship between these parameters and the prognosis. Using the classification proposed by Weiss, 19 tumors were classified as carcinomas and 11 as adenomas. Ki 67 and histone mRNA labeling indices (LIs, the percentage of Ki 67-positive and histone mRNA-positive tumor cells, respectively) were significantly higher in carcinomas than in adenomas (Ki 67 LI was 14.62+/-5.79 in adenomas and 20.35+/-6.23 in carcinomas, p=0.02. Histone mRNA LI was 1.73+/-1.71 in adenomas and 6.62+/-2.28 in carcinomas, p=0.00). The proliferative activity assessed by histone mRNA was lower than that assessed by Ki 67 in both diagnostic groups. The cut off point for the diagnosis of malignancy was found to be 14.55 for Ki 67 LI and 5.75 for histone mRNA LI. A correlation was found between a histone mRNA LI>or=5 and poor prognosis (recurrence, metastasis, or death). We concluded that the proliferative activity of the tumor assessed by Ki 67 and histone mRNA may assist in differentiating adrenocortical adenomas and carcinomas. In addition, our results suggest that the most reliable parameter to predict prognosis in pediatric adrenocortical tumors is the histone mRNA LI.
儿童肾上腺皮质肿瘤较为罕见。使用组织学标准将这些肿瘤分类为腺瘤或癌通常很困难。目前正在研究增殖标志物的免疫组化表达，以用于鉴别诊断和临床结果预测。组蛋白作为肾上腺皮质肿瘤预后标志物的价值尚未阐明。我们评估了30例儿童肾上腺皮质肿瘤的组织学特征、Ki 67免疫组化染色及组蛋白mRNA原位杂交情况。我们研究了这些参数与预后之间的关系。根据Weiss提出的分类方法，19例肿瘤被分类为癌，11例为腺瘤。癌组织中Ki 67和组蛋白mRNA标记指数（LIs，分别为Ki 67阳性和组蛋白mRNA阳性肿瘤细胞的百分比）显著高于腺瘤（腺瘤中Ki 67 LI为14.62±5.79，癌中为20.35±6.23，p = 0.02。腺瘤中组蛋白mRNA LI为1.73±1.71，癌中为6.62±2.28，p = 0.00）。在两个诊断组中，通过组蛋白mRNA评估的增殖活性均低于通过Ki 67评估的增殖活性。发现诊断恶性肿瘤的Ki 67 LI临界值为14.55，组蛋白mRNA LI临界值为5.75。发现组蛋白mRNA LI≥5与预后不良（复发、转移或死亡）之间存在相关性。我们得出结论，通过Ki 67和组蛋白mRNA评估的肿瘤增殖活性可能有助于鉴别肾上腺皮质腺瘤和癌。此外，我们的结果表明，预测儿童肾上腺皮质肿瘤预后最可靠的参数是组蛋白mRNA LI。
