ADRENAL-CORTICAL CARCINOMA WITH A LIVER METASTASIS IN A CHILD - REPORT OF A CASE WITH FINE-NEEDLE ASPIRATION FINDINGS AND IMAGE-ANALYSIS OFNUCLEAR-DNA

BACKGROUND: Adrenal cortical carcinoma is a rare and highly malignant neoplasm. Liver metastases from it may require special differential te chniques in addition to cytologic findings. CASE: A 14-month-old child had adrenal cortical carcinoma and a liver metastasis confirmed by fi ne needle aspiration biopsy (FNAB). Histologic and clinical criteria o f malignancy only partially applied to this tumor. Immunohistochemical analysis of both the primary tumor and metastasis supported an adrena l cortical origin. Other ancillary tests-DNA ploidy, proliferation ind ex (proliferating cell nuclear antigen, Ki-67) and p53 protein immunol ocalization-were utilized in a diagnostic sequence. Flow cytometric an d image analysis of DNA ploidy of the primary tumor gave similar resul ts. Assessment of DNA content of the adrenal cortical carcinoma and li ver 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 co rtical car cinema. The validity of these tests is enhanced with the us e of image-based quantitative approaches that provide greater reproduc ibility and objectivity of their results.