Tartour E, Caillou B, Tenenbaum F, Schröder S, Luciani S, Talbot M, Schlumberger M
Department of Nuclear Medicine, Institut Gustave Roussy, Villejuif, France.
Cancer. 1993 Dec 1;72(11):3296-303. doi: 10.1002/1097-0142(19931201)72:11<3296::aid-cncr2820721127>3.0.co;2-4.
The diagnosis of adrenocortical carcinoma (ACC) may be difficult with conventional light microscopy, especially when the tumor is nonfunctioning. Until now, no specific adrenocortical tumor marker was available. The current study was undertaken to investigate the interest of the D11 MoAb for the diagnosis and prognosis of ACC.
Eighteen adrenocortical carcinomas, 10 primary adrenomedullary tumors, 20 primary hepatocellular carcinomas, 50 primary renal cell carcinomas, 5 primary lung carcinomas, and 18 intraadrenal metastases were analyzed immunohistochemically with the D11 monoclonal antibody. ACC were also evaluated for the expression of other tumor markers, including neuron-specific enolase, chromogranin A, S-100, Leu-7, vimentin, KL1, AE1AE3, and epithelial membrane antigen. Relationships between clinical features and results of immunohistochemistry were also sought.
Nuclear D11 staining appears to be highly specific for normal adrenocortical cells and related tumors. Nuclear D11 positivity was demonstrated in 44% of ACC and was restricted to well-differentiated tumors. No cytoplasmic or nuclear D11 staining was observed in adrenomedullary tumors. D11 reactivity confined to the cytoplasm was found in 5 of 18 adrenal metastases, in all 20 hepatocellular carcinomas tested, in 3 of 5 lung carcinomas, and in 1 of 50 primary renal cell carcinomas. Patients with nuclear D11 immunostaining were initially seen with metastases less often and survived longer than those with no nuclear D11 immunostaining (P < 0.05).
Nuclear D11 immunoreactivity may help to differentiate ACC from intraadrenal metastases and adrenomedullary tumors. This also selects a group of ACC patients with a more favorable outcome.
肾上腺皮质癌（ACC）的诊断采用传统光学显微镜检查可能存在困难，尤其是肿瘤无功能时。到目前为止，尚无特异性肾上腺皮质肿瘤标志物。本研究旨在探讨D11单克隆抗体（MoAb）在ACC诊断和预后评估中的价值。
采用D11单克隆抗体对18例肾上腺皮质癌、10例原发性肾上腺髓质肿瘤、20例原发性肝细胞癌、50例原发性肾细胞癌、5例原发性肺癌和18例肾上腺内转移瘤进行免疫组织化学分析。还评估了ACC中其他肿瘤标志物的表达，包括神经元特异性烯醇化酶、嗜铬粒蛋白A、S-100、Leu-7、波形蛋白、KL1、AE1AE3和上皮膜抗原。同时研究临床特征与免疫组织化学结果之间的关系。
细胞核D11染色对正常肾上腺皮质细胞及相关肿瘤具有高度特异性。44%的ACC显示细胞核D11阳性，且仅限于高分化肿瘤。肾上腺髓质肿瘤未观察到细胞质或细胞核D11染色。在18例肾上腺转移瘤中的5例、所有20例检测的肝细胞癌、5例肺癌中的3例以及50例原发性肾细胞癌中的1例中发现D11反应仅限于细胞质。细胞核D11免疫染色阳性的患者最初出现转移的频率低于无细胞核D11免疫染色的患者，且生存期更长（P < 0.05）。
细胞核D11免疫反应性可能有助于鉴别ACC与肾上腺内转移瘤及肾上腺髓质肿瘤。这也筛选出了一组预后较好的ACC患者。
