Adrenal cortical carcinoma with a liver metastasis in a child. Report of a case with fine needle aspiration findings and image analysis of nuclear DNA

BACKGROUND: Adrenal cortical carcinoma is a rare and highly malignant neoplasm. Liver metastases from it may require special differential techniques in addition to cytologic findings. CASE: A 14-month-old child had adrenal cortical carcinoma and a liver metastasis confirmed by fine needle aspiration biopsy (FNAB). Histologic and clinical criteria of malignancy only partially applied to this tumor. Immunohistochemical analysis of both the primary tumor and metastasis supported an adrenal cortical origin. Other ancillary tests-DNA ploidy, proliferation index (proliferating cell nuclear antigen, Ki-67) and p53 protein immunolocalization-were utilized in a diagnostic sequence. Flow cytometric and image analysis of DNA ploidy of the primary tumor gave similar results. Assessment of DNA content of the adrenal cortical carcinoma and liver metastasis by image analysis showed identical patterns. CONCLUSION: The applicability of new diagnostic techniques to FNAB material may provide new objective measures of the biologic potential of adrenal cortical carcinoma. The validity of these tests is enhanced with the use of image-based quantitative approaches that provide greater reproducibility and objectivity of their results.