Classical Histopathology and Immunohistochemistry



The histopathological diagnosis of adrenocortical carcinoma (ACC) and its differentiation from adrenal adenomas based on nine criteria: nuclear structures, mitotic rate, atypical mitoses, less than 26% clear cells, diffuse architecture, invasion of intratumorous sinusoidal structures, invasion of veins, invasion of capsule, and necroses. If three or more criteria are present and a metastasis of an extra-adrenal tumor or a primary medullary tumor are excluded by structural characteristics or immunohistochemical stainings, an ACC can be diagnosed. Its weight should exceed 100 g, its size should be larger than 5 cm. The typical immunohistochemical marker profile comprehends negativity for chromogranin A and (mostly) for keratin and an expression of inhibin, melan A, calretinin, and (mostly) synaptophysin. The Ki-67 index should exceed 3%. The differential diagnosis to medullary tumors, metastases, and other tumors are presented. The TNM-system for staging is discussed.


Epithelial Membrane Antigen Adrenocortical Carcinoma Adrenal Adenoma Adrenocortical Tumor Regressive Change 


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Institute of Pathology of the MarienkrankenhausHamburgGermany

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