Image cytometric DNA analysis of adrenocortical neoplasms as a prognostic parameter: a clinico-pathologic study of 13 patients.

Formalin-fixed paraffin-embedded material of thirteen adrenocortical neoplasms were examined by conventional microscopy, and by DNA image cytometry in Feulgen-stained tissue sections and cytospin preparations. The subsequent clinical course of each patient was reviewed. Seven of the neoplasms were classified according to the histologic criteria of Weiss as adenomas and six as carcinomas. The DNA content and indices of all 13 adrenocortical neoplasms were measured by image cytometry. For the internal standard, the DNA values of the adjacent normal adrenal cells in 10 cases and of nuclei of fibrocytes of the tumour stroma were determined. DNA values in all seven adenomas, in normal adrenal cells, and in the nuclei of fibrocytes were unequivocally diploid. The six carcinomas expressed aneuploid, tetraploid or hypertetraploid DNA values. DNA values of normal adrenal cells seemed to provide a better internal control than those of connective tissue cells. Of the seven adenoma patients with a follow-up between 8 and 124 months (mean 59 months), six were alive without evidence of tumour; one patient died from other causes. Of the six carcinoma patients with a follow-up ranging from 5 days to 36 months, three patients died from the disease; one patient was alive with metastases, and only two patients were alive without evidence of the disease for 25 and 36 months, respectively. Our results strongly suggest that image cytometric DNA analysis is a valuable method to distinguish between benign and malignant adrenocortical neoplasms.