ADRENOMEDULLARY AND ADRENOCORTICAL NEOPLA SIAS - MORPHOLOGICAL TYPING, ASSESSMENT OF BIOLOGICAL POTENTIAL, PROGNOSIS AND ETIOLOGY

The aim of morphological tumour diagnosis is to answer clinical questi ons on type, biological potential, prognosis and aetiology of individu al neoplasms. The limitations and perspectives of different methods us ed in the diagnosis of adrenal tumours, ranging from histology to mole cular genetic DNA analyses, are described. When surgical specimens fro m adrenal neoplasms cannot be typed on the basis of histology and/or w ith clinica data (e. g., endocrine symptoms and history) as adrenocort ical tumours, phaeochromocytomas or metastases to the adrenal, immunoh istological investigations with a panel of different antibodies are ne cessary. After identification of the tissue derivation of an individua l adrenal tumour, its biological potential must be assessed. Among adr enocortical neoplasms? adenomas and carcinomas can be distinguished by evaluation of various histological parameters (including structural f eatures and signs of invasion) according to defined algorithms. In add ition, conventional histology (by estimation of mitotic activity) allo ws the discrimination of tumours with especially high malignant potent ial from other adrenocortical carcinomas. In contrast, among adrenomed ullary tumours even the combined use of histological, immunohistologic al and DNA cytophotometric techniques only allows the definition of ri sk groups (benign versus suggestive of malignancy), while reliable rec ognition of an individual malignant phaeochromocytoma is so far imposs ible. The question as to whether a particular phaeochromocytoma repres ents a sporadic tumour or a neoplasm inherited as one feature of a def ined syndrome cannot be answered with the above methods, but only by t he application of molecular genetic techniques.