CYTOMORPHOLOGY OF ADRENOCORTICAL CARCINOMA AND COMPARISON WITH RENAL-CELL CARCINOMA

OBJECTIVE: To review the cytomorphologic features of adrenocortical ca rcinoma (ACC), correlate them with histology and compare them with the cytomorphologic features of very similar renal cell carcinoma (RCC) o n fine needle aspiration (FNA) smears. STUDY DESIGN: Cytomorphologic f eatures in 7 cases of ACC in FNA smears were analyzed and compared wit h those in 10 cases of RCC. Five cases of ACC and five of RCC were lat er confirmed on histopathology. Parameters analyzed pertained mainly t o architectural, cytoplasmic and nuclear features. RESULTS: The presen ce of cells in sheets with a central, thin-walled vascular core (endoc rine vascular pattern); monomorphic cell population; eccentric nuclei; focal dramatic anisonucleosis; and focal spindling with crushing was a prominent feature of ACC in contrast to RCC, which showed mainly an acinar pattern with only a focal endocrine pattern, well-defined cytop lasmic angles and projections, and cytoplasmic vacuolations; pleomorph ism, if present, was gradual and seen uniformly in all the cells. Univ ariate analysis using the (2)(chi) test showed the presence of endocri ne architecture; focal dramatic anisonucleosis; crushed spindle fragme nts; eccentric nuclei; and absence of cytoplasmic vacuolizations as si gnificant differentiating features in favor of ACC (P < .05).CONCLUSIO N: A cytomorphologic comparison of ACC with RCC showed that differenti ation is possible by a set of statistically significant features that not only have diagnostic value but, as with crushed spindle fragments, also have prognostic significance.