Genetic and Molecular Biology Studies

Currently, the only accepted criteria to determine whether a clinically inapparent adrenal mass is benign or malignant are metastasis (synchronous or metachronous) and local invasion into adjacent structures. The mapping and identification of genes responsible for hereditary syndromes (e.g., multiple endocrine neoplasia type 1, Li-Fraumeni syndrome) have increased our understanding of adrenocortical tumorigenesis. Oncogenes and tumor suppressor genes involved in adrenal carcinomas include mutations in the p53 tumor suppressor gene. Among those, the Ki-67 index (percentage of immunopositive cells), when above 5%, can be a useful indicator in the differentiation of adenomas from carcinomas.52 Adrenal carcinomas are monoclonal, whereas adrenal adenomas may be polyclonal in approximately 25% to 40% of cases.53 Although these findings do not have direct clinical application, it is hoped that future research will facilitate the diagnosis and predict the natural course of these tumors.

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FIGURE 67-3. The positron emission tomography scan detected a small isolated adrenal metastasis (arrow) (with a concurrent negative CT scan) in this 69-year-old man who had been treated for mesothelioma in the past. Laparoscopic adrenalectomy allowed full extirpation of this single metastasis.

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FIGURE 67-3. The positron emission tomography scan detected a small isolated adrenal metastasis (arrow) (with a concurrent negative CT scan) in this 69-year-old man who had been treated for mesothelioma in the past. Laparoscopic adrenalectomy allowed full extirpation of this single metastasis.

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