mart-1-antigen and Adrenal-Cortex-Neoplasms

Topics: Adrenal Cortex Neoplasms; Adrenocortical Adenoma; Adult; Diagnosis, Differential; Diagnostic Errors; Humans; Immunohistochemistry; Immunophenotyping; Inhibins; MART-1 Antigen; Middle Aged; Neoplasm Proteins; Neuroendocrine Tumors; S100 Proteins; Synaptophysin; Vimentin

In daily routine pathology of the adrenal glands three tumor entities are important: adrenocortical tumors, adrenomedullary tumors and metastases. The differentiation of these three main tumor types can often be difficult structurally but immunostaining enables a definite diagnosis in nearly all cases. Adrenocortical tumors are positive for steroidogenic factor 1 and melan-A and always negative for chromogranin A whereas adrenomedullary tumors express chromogranin A but never keratin. A broad spectrum of antibodies is available for the identification of metastases and even the rare epithelioid angiosarcomas. For adrenocortical tumors, adenomas and carcinomas can be differentiated using three scoring systems and the Ki-67 index in adenomas should not exceed 3%. Using scoring systems and the Ki-67 index approximately 90% of cortical tumors can be differentiated into benign or malignant tumors. For pheochromocytomas two scoring systems are used for differentiating benign and malignant tumors but the results are less dependable.

Topics: Adrenal Cortex Neoplasms; Adrenal Gland Neoplasms; Adrenal Glands; Adrenal Medulla; Adrenocortical Adenoma; Biomarkers, Tumor; Chromogranin A; Humans; Keratins; MART-1 Antigen; Pheochromocytoma; Steroidogenic Factor 1

The authors report a case of myxoid adrenal cortical carcinoma (ACC) clinically manifesting as primary hyperaldosteronism. The 82-year-old female patient had a history of hypertension and was sent to the emergency room because of change in consciousness. Ventricular fibrillation occurred, and severe hypokalemia was found. Increased renal loss of potassium, high serum aldosterone level, low renin activity, and a huge tumor in the left suprarenal area were revealed when tests were conducted to determine the cause of her hypokalemia. Left adrenalectomy was performed. The tumor measured 13 cm in diameter and showed a heterogeneous cut surface with gelatinous material. Microscopically, the lesion was composed of polygonal cells with eosinophilic cytoplasm and arranged in arborizing cords in a myxoid background. Capsular and vascular invasion were observed. The tumor stained positive for synaptophysin, melan-A, vimentin, and α-inhibin but negative for cytokeratin. A primary myxoid ACC was diagnosed, which is a rare histological variant. The authors review 13 other reported cases. Most of these were functional tumors causing Cushing syndrome, and only 2 cases presented as primary hyperaldosteronism. All cases had similar microscopic and immunohistochemical features. Distal metastases and local recurrence were not uncommon. Close clinical follow-up is imperative.

Topics: Adrenal Cortex Neoplasms; Adrenalectomy; Adrenocortical Carcinoma; Aged, 80 and over; Biomarkers, Tumor; Diagnosis, Differential; Female; Humans; Hyperaldosteronism; Inhibins; MART-1 Antigen; Mucins; Synaptophysin; Treatment Outcome; Vimentin

Melan-A/MART-1 is a recently identified new melanocytic differentiation marker, which is recognized as an antigen on melanoma cells by cytotoxic T-lymphocytes. It is of interest for clinicians as potential immunotherapeutic target and it is relevant for pathologists as a novel diagnostic marker, since two antibodies (A103 and M2-7C10) have become available to study Melan-A/MART-1 expression on archival material. Both antibodies are useful in the differential diagnosis of melanocytic tumors, especially metastatic tumors, since they are more sensitive than HMB-45. Both antibodies are also of diagnostic value in the recognition of perivascular epithelioid cell tumors (angiomyolipoma, lymphangioleiomyomatosis, and clear cell tumor). Since A103 has the unique property of staining many steroid hormone producing cells, this antibody is also of value for the recognition of tumors derived from these cells, such as adrenocortical carcinomas. Both antibodies are likely to be included in the routine diagnostic armamentarium of many immunohistochemical laboratories in the near future.

Topics: Adrenal Cortex Neoplasms; Angiomyolipoma; Antibodies, Monoclonal; Antigens, Differentiation; Antigens, Neoplasm; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Lymphangioleiomyomatosis; Lymphatic Metastasis; Male; MART-1 Antigen; Melanocytes; Melanoma; Neoplasm Proteins; Ovarian Neoplasms; Skin Neoplasms; Testicular Neoplasms

Adrenocortical carcinoma (ACC) is an uncommon primary cancer in the adrenal gland. Its incidence of showing metastasis in the head and neck region is very rare. Herein, we present a case of a 46-year-old man who presented with complaints of pain and numbness on the left side of the lower face for 4 months. Radiographic examination revealed an osteolytic lesion with an ill-defined border in the left body region of the mandible. Histopathologic examination revealed a tumor composed of sheets of oval to polygon-shaped tumor cells predominantly displaying abundant eosinophilic granular cytoplasm. These tumor cells showed features of a high degree of anaplasia. On immunohistochemical examination, tumor cells were focally positive for synaptophysin, inhibin, vimentin, pancytokeratin (pan-CK), cytokeratin (CK)5/6, CD68, and CK8/18 and immunonegative for CK7, chromogranin, melan-A, S100, SMA, and SATB2. The Ki-67 proliferation index was approximately 20%. To the best of our knowledge, this is the first case of metastatic oncocytic ACC to the oral cavity region.

Topics: Adrenal Cortex Neoplasms; Adrenocortical Carcinoma; Biomarkers, Tumor; Chromogranins; Humans; Inhibins; Keratins; Ki-67 Antigen; Male; Mandible; MART-1 Antigen; Middle Aged; Synaptophysin; Vimentin

We report two cases of patients presenting myxoid variant of adrenocortical carcinoma (ACC). This very rare variant is characterized by a tumoral proliferation organized in trabeculae, cords or even pseudo-glands within an acellular myxoid materiel stained by Alcian Blue and negative for PAS. Tumor cells have a small to medium size and have little atypia. Their immunohistochemical profil (positivity of Synaptophysin, SF1, Melan A, Vimentin and Inhibin, with a weak or negative pancytokeratin expression) eliminate the main differential diagnoses (metastasis of a myxoid adenocarcinoma and soft tissue myxoid tumor). Many scoring systems have been proposed in order to evaluate the risk of malignancy of these lesions: the Weiss score seems less efficient to evaluate malignancy in this variant than the reticulinic algorithm or the Helsinki score. Prognosis of myxoid variant of ACC seems worse than classical ACC.

Topics: Adrenal Cortex Neoplasms; Adrenocortical Carcinoma; Biomarkers, Tumor; Humans; MART-1 Antigen; Prognosis; Vimentin

Topics: Adrenal Cortex Neoplasms; Adrenocortical Carcinoma; Adult; Aged; Antibodies, Monoclonal, Murine-Derived; Biomarkers, Tumor; Female; Humans; Inhibins; Ki-67 Antigen; Male; MART-1 Antigen; Matrix Metalloproteinase 9; Middle Aged; Prognosis; Retrospective Studies; Survival Rate; Synaptophysin; Young Adult

Adrenocortical carcinomas (ACCs) with myxoid features are rare neoplasms. We identified 7 cases of myxoid ACC and studied the clinicopathologic and immunohistochemical features of these neoplasms. The patients were 5 men and 2 women with a mean age of 45 years. Histologically, the tumors contained alcian blue-positive myxoid areas ranging from 10% to 50% of the tissue examined. One case showed lipomatous metaplasia. Areas of conventional ACC were present in all cases. Immunohistochemically, the tumors were positive for steroid receptor cofactor 1, inhibin, melan A, calretinin, and synaptophysin but negative for high-molecular-weight cytokeratin, CAM5.2, and Pax8. Clinical follow-up information for 4 patients demonstrated that all patients had died of their disease 11 to 69 months after diagnosis. Myxoid ACCs are rare tumors that expand the differential diagnosis of myxoid neoplasms involving the retroperitoneum. Contrary to previous reports proposing that the biologic behavior is similar to conventional ACC, our series seems to indicate that myxoid morphology is associated with more aggressive behavior.

Topics: Adrenal Cortex Neoplasms; Adrenocortical Carcinoma; Adult; Aged; Calbindin 2; Female; Humans; Immunohistochemistry; Inhibins; Male; MART-1 Antigen; Metaplasia; Middle Aged; S100 Calcium Binding Protein G; Synaptophysin

Tumors of the adrenal glands are among the most frequent tumors in cattle; however, few studies have been conducted to describe their characteristics. The aim of this study was to classify 41 bovine adrenal neoplasms from 40 animals based on macroscopic and histologic examination, including electron microscopy and immunohistochemistry for melan A, synaptophysin, chromogranin A, vimentin, pan-cytokeratin, 2',3'-cyclic nucleotide-3'-phosphohydrolase (CNPase), and Ki-67. The tumors were classified as 23 adrenocortical adenomas, 12 adrenocortical carcinomas, 2 schwannomas, 2 pheochromocytomas (1 malignant), and 1 ganglioneuroma. Five histologic features were characteristic of metastasizing adrenocortical tumors: invasion of the capsule, vascular invasion, diffuse growth pattern, spindle-cell morphology, and nuclear pleomorphism. Adrenocortical tumors with at least 3 of these features were classified as malignant. Immunohistochemically, adrenocortical tumors expressed melan A (16/19), vimentin (14/26), cytokeratin (11/26), and chromogranin A (9/27), whereas pheochromocytomas expressed chromogranin A (2/2), synaptophysin (2/2), and vimentin (1/2). Both schwannomas expressed CNPase. An immunohistochemistry panel consisting of antibodies against melan A, synaptophysin, and CNPase was considered most useful to classify bovine adrenal tumors. However, the distinction between benign and malignant adrenocortical tumors was based on histologic features as in human medicine.

Topics: 2',3'-Cyclic-Nucleotide Phosphodiesterases; Abattoirs; Adrenal Cortex Neoplasms; Adrenal Gland Neoplasms; Adrenal Glands; Adrenocortical Adenoma; Adrenocortical Carcinoma; Animals; Biomarkers, Tumor; Cattle; Cattle Diseases; Chromogranin A; Denmark; Humans; Immunohistochemistry; Keratins; MART-1 Antigen; Microscopy, Electron; Synaptophysin; Vimentin

Topics: Adenoma; Adrenal Cortex Neoplasms; Aged; Antigens, Neoplasm; Biomarkers, Tumor; CD56 Antigen; Cell Dedifferentiation; Cell Transformation, Neoplastic; Female; Humans; MART-1 Antigen; Neoplasm Proteins; Synaptophysin

Most adrenocortical tumors (ACTs) can be diagnosed directly by a combination of morphologic features and clinical findings. However, sometimes it may be difficult to distinguish ACTs from other neoplasms such as pheochromocytomas and some metastatic tumors, particularly for small biopsy specimens because they may be morphologically similar. Expression of calretinin has recently been suggested as a valuable immunomarker for the differential diagnosis between ACTs and other tumors; however, its diagnostic value is still under debate. To determine the diagnostic value of calretinin in Chinese patients with adrenocortical and non-ACTs, we employed both polyclonal and monoclonal anticalretinin to characterize the expression of calretinin in adrenal tissues and compared its expression with that of inhibin alpha, Melan-A, cytokeratin, or CD99 by immunohistochemistry in tissue microarrays and standard tissue sections of 414 specimens. Our results revealed that calretinin was expressed by adrenocortical cells, but not by the other cells tested and the percentage of calretinin-positive ACTs reached 99% when stained with polyclonal antibodies, which was higher than that with monoclonal anticalretinin (91.3%), anti-Melan-A (90.3%), antiinhibin alpha (81.6%). In addition, our results also revealed that ACTs were stained by cytokeratin (AE1/AE3) with variable degrees (58.7%). Furthermore, unlike anti-Melan-A that stained all metastatic malignant melanoma, anticalretinin did not recognize other tested tumors. Therefore, immunohistologic staining with polyclonal anticalretinin is more sensitive than other antibodies tested for the diagnosis of ACTs. However, monoclonal anticalretinin appeared to be more specific. Importantly, our data suggested that the fried-egg-like staining pattern, but not the mere cytoplasmic staining, was characteristic of anticalretinin staining in adrenocortical tissues. Notably, a few anticalretinin negative-ACTs were stained by other immunomarkers that we tested. Thus, the combinational characterization of calretinin (either by polyclonal or monoclonal antibody), inhibin alpha, and Melan-A expression is of great significance in the differential diagnosis of ACTs.

Topics: Adrenal Cortex Neoplasms; Antigens, Neoplasm; Biomarkers, Tumor; Calbindin 2; Diagnosis, Differential; Humans; Immunohistochemistry; Inhibins; MART-1 Antigen; Microarray Analysis; Neoplasm Proteins; S100 Calcium Binding Protein G

Topics: Adenoma, Oxyphilic; Adrenal Cortex Neoplasms; Antigens, Neoplasm; Female; Humans; Hydrocortisone; Immunohistochemistry; Keratins; MART-1 Antigen; Middle Aged; Neoplasm Proteins; Synaptophysin; Testosterone; Vimentin

Myxoid variant of adrenocortical carcinomas (ACC) are rare, there being only 11 cases in the literature to date. Reported herein are the findings of a case, which in contrast to all previously reported myxoid ACC, was devoid of typical non-myxoid areas. The patient was a 61-year-old man in whom a left adrenal mass was detected during investigation of Cushing's syndrome. The adrenal was replaced by malignant cells and expanses of myxoid material. The cells were positive for melan-A, synaptophysin, vimentin and alpha-inhibin. The ultrastructural features of the cells were typical of adrenal cortical differentiation. The differential diagnosis of myxoid ACC includes extraskeletal myxoid chondrosarcoma, chordoma, myxoid adenocarcinoma, myxoma, lipomatous tumors, nerve sheath tumors, smooth muscle tumors, gastrointestinal stromal tumor and other sarcomas. The presence of myxoid material in a retroperitoneal lesion raises a broad differential diagnosis in which myxoid adrenocortical neoplasms should be included. Clinicoradiological correlation may be helpful, but special stains, immunohistochemistry and ultrastructural examination may be necessary to establish the diagnosis.

Topics: Adenocarcinoma; Adrenal Cortex Neoplasms; Adrenocortical Carcinoma; Antigens, Neoplasm; Chordoma; Diagnosis, Differential; Humans; Immunohistochemistry; Male; MART-1 Antigen; Microscopy, Electron; Middle Aged; Myxoma; Neoplasm Proteins; Nerve Sheath Neoplasms; Retroperitoneal Neoplasms; Synaptophysin; Vimentin

To investigate the potential diagnostic value of A103 and inhibin-alpha in adrenocortical tumors and to evaluate the applicability of tissue microarray/tissue chip in pathological studies using immunohistochemistry.. A tissue microarray/tissue chip was constructed to contain 179 formalin-fixed, paraffin-embedded adrenal tissue samples which include 3 normal adrenal cortex, 2 fetal adrenal cortex, 2 nodular adrenocortical hyperplasia samples, 72 adrenocortical adenomas, 39 adrenocortical carcinomas, 3 adrenal medulla, 13 metastatic carcinomas, 4 metastatic malignant melanomas and 44 pheochromocytomas. Additional 20 cases of normal adult adrenal gland were used as controls. Immunohistochemical markers, including A103, inhibin-alpha, calretinin and Ki-67 were used on the tissue array sections by EnVision immunohistochemical staining methods.. Positive staining of A103 was seen in all of the 23 (100%) adrenal cortex, 2 fetal adrenal cortex, 2 nodular adrenocortical hyperplasia samples, 60 of 66 (90.9%) adrenocortical adenomas samples, 35 of 37 (94.6%) adrenocortical carcinomas samples, 3 of 3 malignant melanomas, but in none of the adrenal medulla, pheochromocytomas or adrenal metastatic carcinoma samples. In all of the adrenal cortex, fetal adrenal cortex and nodular adrenocortical hyperplasia cases, inhibin-alpha immunoreactivity was limited to the zona reticularis and the innermost zona fasciculata. Fifty of the 66 (75.8%) adrenocortical adenomas, 28 of the 37 (75.7%) adrenocortical carcinomas were positive for inhibin-alpha. None of the adrenal medulla, pheochromocytoma, metastatic malignant melanoma or carcinoma samples showed a positive inhibin-alpha immunostain.. The tissue microarray/tissue chip technique provides a reliable method to investigate marker expression by offering a rapid, economic and accurate screening of tissue specimens on a large scale. The combined use of A103 and inhibin-alpha is valuable in distinguishing adrenocortical tumor from pheochromocytoma and other metastatic neoplasms.

Topics: Adrenal Cortex; Adrenal Cortex Neoplasms; Adrenocortical Adenoma; Adult; Antigens, Neoplasm; Female; Humans; Immunohistochemistry; Inhibins; Male; MART-1 Antigen; Neoplasm Proteins; Oligonucleotide Array Sequence Analysis; Pheochromocytoma

Morphologic distinction between adrenal cortical and medullary tumors can be difficult. Previous studies have shown inhibin, melan-A, and BCL-2 to be useful markers for adrenal cortical tumors. We have recently observed a high level of calretinin expression in normal adrenal cortex but not the medulla and therefore evaluated its diagnostic application for adrenal tumors in comparison with inhibin, melan-A, and BCL-2. C-kit is a transmembrane tyrosine kinase receptor. Immunodetection of c-kit expression has been recently used for tumor diagnosis, and c-kit-positive tumors can potentially benefit from kit kinase inhibitor treatment. Although c-kit expression was reported in adrenal medulla and pheochromocytoma, it has not been evaluated in adrenal cortical tumors. In this study, 28 adrenal cortical tumors (12 carcinomas, 16 adenomas), 20 pheochromocytomas, and 20 extraadrenal paragangliomas were evaluated for calretinin, inhibin, melan-A, BCL-2, and c-kit expression by standard immunohistochemical assays on paraffin sections. The percentage of immunoreactivity in adrenal cortical tumors was as follows: calretinin, 96%; melan-A, 89%; inhibin, 92%; BCL-2, 20%; and c-kit, 5%. Normal adrenal medulla did not stain for c-kit but was positive for BCL-2. Eighty-six percent of pheochromocytomas stained for BCL-2 and none for calretinin, with the exception of the ganglioneuromatous areas in composite pheochromocytomas (n = 5). Extraadrenal paragangliomas showed reactivity with calretinin in 25%, melan-A in 5%, inhibin in 16%, BCL-2 in 38%, and c-kit in 8% of the cases. Our results indicate that calretinin is the most sensitive among all the adrenal markers tested. Like melan-A and inhibin, calretinin is also a very specific marker in differentiating cortical from medullary adrenal tumors. In addition, calretinin can be used to confirm a composite pheochromocytoma. BCL-2 does not appear to be useful in differentiating adrenal cortical from medullary tumors. C-kit is not useful in the diagnosis of adrenal tumors, and kit kinase inhibitor might have a limited role in the treatment of adrenal tumors and paraganglioma because of the low frequency of c-kit expression in these tumors.

Topics: Adrenal Cortex Neoplasms; Adrenal Medulla; Antigens, Neoplasm; Biomarkers, Tumor; Calbindin 2; Diagnosis, Differential; Humans; Immunohistochemistry; Inhibins; MART-1 Antigen; Neoplasm Proteins; Pheochromocytoma; Proto-Oncogene Proteins c-bcl-2; Proto-Oncogene Proteins c-kit; S100 Calcium Binding Protein G

To evaluate the potential diagnostic role of A103 and inhibin alpha in adrenocortical adenoma and the feasibility of tissue microarray/tissue chips.. A series of adrenal gland tissue chips were prepared, including 79 cases of formalin-fixed, paraffin-embedded tissue from 3 normal adrenal glands, 66 adrenocortical adenomas, 5 cases of metastatic carcinoma and 5 pheochromocytomas. A103 and inhibin alpha were detected with Envision immunohistochemical staining methods.. Positive staining was seen in 3 of 3 (100%) adrenal cortices and in 55 of 61(90.2%) adrenocortical adenomas but in none of the pheochromocytomas or adrenal metastatic carcinomas. In the 3 of 3(100%) adrenal cortices, inhibin alpha immunoreactivity was limited to the zona reticularis and the innermost zona fasciculata. 51 of 61(83.6%) adrenocortical adenomas reacted with inhibin alpha. None of the pheochromocytomas or metastatic carcinomas reacted with inhibin alpha.. High-throughput tissue microarray/tissue chip offers a powerful strategy for rapid identification in situ. It is feasible to utilize tissue microarray for a rapid, economic and accurate screening of tissue specimens on a large scale. The combined use of A103 and inhibin alpha is valuable in distinguishing adrenocortical adenoma from pheochromocytoma and other metastatic carcinomas.

Topics: Adrenal Cortex; Adrenal Cortex Neoplasms; Adrenocortical Adenoma; Antibodies, Monoclonal; Antigens, Neoplasm; Humans; Inhibins; MART-1 Antigen; Neoplasm Proteins; Oligonucleotide Array Sequence Analysis

Most adrenocortical neoplasms, renal cell carcinomas, and hepatocellular carcinomas are diagnosed by a combination of clinical and morphologic features. However, occasionally this histologic differential diagnosis requires additional ancillary tests, such as immunohistochemistry. The authors investigated the potential value of A103 in the differential diagnosis of these tumors. Thirty-two adrenocortical neoplasms, 86 renal cell carcinomas, and 57 hepatocellular carcinomas were evaluated by immunohistochemistry using a monoclonal antibody A103 and a standard ABC method. The adrenocortical neoplasms were 21 adenomas and 11 carcinomas. Thirty-one of the 32 adrenocortical neoplasms showed strong and diffuse granular cytoplasmic staining for Melan A. No nuclear reaction was observed. There were no differences in staining patterns between adrenocortical adenomas and carcinomas. With the exception of one clear cell renal cell carcinoma, all non-adrenocortical neoplasms were negative. The authors conclude that A103 is a useful addition to the immunohistochemical panel in the differential diagnosis of adrenocortical neoplasms from both renal cell and hepatocellular carcinomas. This marker, however, does not separate benign from malignant adrenocortical neoplasms.

Topics: Adrenal Cortex Neoplasms; Antibodies, Monoclonal; Antigens, Neoplasm; Carcinoma, Hepatocellular; Carcinoma, Renal Cell; Diagnosis, Differential; Humans; Immunohistochemistry; MART-1 Antigen; Neoplasm Proteins; Sensitivity and Specificity

The monoclonal antibody A103 recognizes an antigen on melanoma cells known as Melan-A or MART-1. Recent studies have shown that A103 also reacts with adrenal cortical cells and may be useful in the diagnosis of adrenal cortical tumors. However, only small numbers of some of the tumors in the differential diagnosis of adrenal cortical neoplasms have been studied.. To study the specificity of A103 immunohistochemistry in a large number of tumors in the differential diagnosis of adrenal cortical neoplasms.. Formalin-fixed, paraffin-embedded tissue from 21 adrenal cortical tumors, 16 cases of metastatic carcinoma to the adrenal, 10 pheochromocytomas, and 269 extra-adrenal carcinomas was evaluated for A103 immunoreactivity using a commercially available antibody (Novocastra, Newcastle, UK).. Positive staining was seen in all of the adrenal cortical tumors but in none of the adrenal metastases or pheochromocytomas. In the 269 extra-adrenal carcinomas, A103 immunoreactivity was limited to a single ovarian serous carcinoma.. A103 immunostaining is useful in distinguishing adrenal cortical neoplasms from other carcinomas and pheochromocytoma.

Topics: Adrenal Cortex Neoplasms; Antibodies, Monoclonal; Antigens, Neoplasm; Humans; Immunohistochemistry; MART-1 Antigen; Neoplasm Proteins; Sensitivity and Specificity

Fine-needle aspiration (FNA) of the adrenal is a useful modality for the evaluation of primary and metastatic neoplasms. Until now, however, few reliable markers existed for the positive identification of adrenal cortical cells. Originally studied as a melanoma marker, Melan-A, as detected by the murine monoclonal antibody, A103, has gained recent attention as a marker for steroid-producing cells. Formalin-fixed, paraffin-embedded cell blocks from 24 adrenal FNA specimens were stained for cytokeratins (AE1/AE3) and Melan-A (A103). Seven of 8 cases containing normal, hyperplastic, and neoplastic adrenal cortical cells were positive for A103. Among 16 cases of metastatic carcinoma, tumor cells in 14 samples were positive for cytokeratins but negative for A103. The A103 monoclonal antibody is a sensitive marker for the identification of normal, hyperplastic, and neoplastic adrenal cortical cells in cell blocks of adrenal FNA specimens. With the exception of melanoma, A103 reactivity is restricted to adrenal cortical and other steroid-producing cells. A103 should be used routinely for the evaluation of FNA specimens of adrenal mass lesions.

Topics: Adrenal Cortex; Adrenal Cortex Neoplasms; Animals; Antibodies, Monoclonal; Antigens, Neoplasm; Biomarkers, Tumor; Biopsy, Needle; Cell Nucleus; Humans; Hyperplasia; Immunohistochemistry; Keratins; MART-1 Antigen; Melanoma; Mice; Neoplasm Proteins

The Melan-A (MART-1) gene encodes an antigen recognized by cytotoxic T cells. It has been said to be restricted in its expression to melanocytes. However, here we report the presence of immunoreactivity for A103, an antibody to Melan-A, in five adrenocortical adenomas, 16 primary and 13 metastatic adrenocortical carcinomas, four Leydig cell tumors of the testis, and three Sertoli-Leydig cell tumors of the ovary. To evaluate the potential diagnostic role of this antibody, we studied immunoreactivity for A103 in 111 carcinomas, 40 germ cell tumors, and 33 miscellaneous nonmelanocytic epithelioid tumors. All of them were negative for A103. Our findings suggest that once melanoma is excluded, A103 can aid in the recognition of steroid hormone-producing tumors and may be particularly useful in the diagnosis of adrenocortical carcinoma. The presence of immunoreactivity for A103 practically excludes any other carcinoma that may enter into the differential diagnosis of adrenocortical tumors.

Topics: Adrenal Cortex Neoplasms; Adrenocortical Adenoma; Adrenocortical Carcinoma; Animals; Antibodies, Monoclonal; Antibodies, Neoplasm; Antigens, Neoplasm; Cross Reactions; Female; Humans; Immunoenzyme Techniques; Leydig Cell Tumor; Male; MART-1 Antigen; Mice; Neoplasm Proteins; Sertoli-Leydig Cell Tumor; Urogenital Neoplasms

Distinguishing adrenal cortical neoplasms from either hepatocellular carcinomas or renal tumors can be difficult. Two recently described antibodies, A103 and inhibin A, are most often reported to be reactive with adrenal cortical neoplasms but with neither hepatocellular carcinoma nor renal cell carcinoma. To compare the sensitivity and specificity of these two antibodies in the diagnosis of adrenal cortical tumors, we stained 22 adrenal cortical adenomas, 4 adrenal cortical carcinomas, 25 hepatocellular carcinomas, and 43 renal tumors, including 33 renal cell carcinomas and 8 oncocytomas, with the A103 and inhibin A using an avidin-biotin complex technique. Fifteen (68%) of 22 adrenal adenomas and 2 (50%) of 4 adrenal cortical carcinomas were reactive with A103. Nineteen (86%) of 22 adrenal adenomas and 3 (75%) of 4 adrenal cortical carcinomas were reactive for inhibin A. None of the renal tumors or hepatocellular carcinomas reacted with A103, but 1 (4%) of 25 hepatocellular carcinomas (a high-grade pleomorphic tumor) and 1 (2%) of 43 renal tumors (a clear-cell renal cell carcinoma) were reactive with inhibin A. The cytoplasmic reactivity for A103 in adrenal tumors was coarsely granular and most common in clear-cell areas. Reactivity for inhibin was either cytoplasmic or membranous and stained both clear-cell and granular areas. We conclude that both antibodies are useful in the immunohistochemical diagnosis of adrenal cortical neoplasms and that A103 is slightly more specific and inhibin slightly more sensitive.

Topics: Adenoma; Adenoma, Oxyphilic; Adrenal Cortex Neoplasms; Antibodies, Monoclonal; Antigens, Neoplasm; Carcinoma, Hepatocellular; Carcinoma, Renal Cell; Diagnosis, Differential; Female; Humans; Immunoenzyme Techniques; Inhibins; Kidney Neoplasms; Liver Neoplasms; Male; MART-1 Antigen; Neoplasm Proteins; Sensitivity and Specificity