Contribution of the microvessel network to the clonal and kinetic profilesof adrenal cortical proliferative lesions

Monoclonal adrenocortical lesions have been characterized by an inverse cor relation between proliferation and apoptosis, and polyp clonal lesions show a direct correlation. Their relationship with the vascular pattern remains unknown in adrenocortical nodular hyperplasias (ACNHs), adenomas (ACAs), a nd carcinomas (ACCs). We studied 20 ACNHs, 25 ACAs, and 10 ACCs (World Heal th Organization classification criteria) from 55 women. The analysis includ ed X-chromosome inactivation assay (on microdissected samples), slide and f low cytometry, and in situ end labeling, Endothelial cells were stained wit h anti-CD31, and the blood vessel area and density were quantified by image analysis in the same areas. Appropriate tissue controls were run in every case. Regression analyses between kinetic and vascular features were perfor med in both polyclonal and monoclonal lesions. Polyclonal patterns were obs erved in 14 of 18 informative ACNHs and 3 of 22 informative ACAs, and monoc lonal patterns were seen in 4 of 18 ACNHs, 19 of 22 ACAs, and 9 of 9 ACCs. A progressive increase in microvessel area was observed in the AC-NH-ACA-AC C transition but was statistically significant between benign and malignant lesions only (191.36 +/- 168.32 v 958.07 +/- 1279.86 mum(2); P <.0001). In addition, case stratification by clonal pattern showed significant differe nces between polyclonal and monoclonal benign lesions; 6% of polyclonal and 57% of monoclonal lesions had microvessel area > 186 mum(2) (p =.0000008). Monoclonal lesions showed parallel trends (but with opposite signs) for mi crovessel area and density in comparison with proliferation and apoptosis, whereas polyclonal lesions showed inverse trends. In conclusion, the kineti c advantage of monoclonal adrenal cortical lesions (increased proliferation , decreased apoptosis) is maintained by parallel increases in microvessel a rea and density. HUM PATHOL 32:1232-1239. Copyright (C) 2001 by W.B. Saunde rs Company.