DETECTION OF CIRCULATING TUMOR CELLS IN PATIENTS WITH ADRENOCORTICAL CARCINOMA: A MONOCENTRIC PRELIMINARY STUDY.

Context:Adrenocortical carcinoma (ACC) is a rare malignancy, the prognosis of which is mainly dependent on stage at diagnosis. The identification of disease-associated markers for early diagnosis and drug monitoring is mandatory. Circulating tumor cells (CTC) are released into the bloodstream from primary tumor/metastasis. CTC detection in blood samples may have enormous potential for assisting diagnosis of malignancy, estimating prognosis and monitoring the disease. Objective:To investigate the presence of CTC in blood samples of patients with ACC or benign adrenocortical adenoma (ACA). Setting:University Hospital. Patients:14 ACC and 10 ACA. Intervention:CTC analysis performed in blood samples from 14 ACC and 10 ACA patients. CTC isolated on the basis of cell size by filtration through ScreenCell® devices, followed by identification according to validated morphometric criteria and immunocytochemistry. Main outcome measure:Difference in CTC detection between ACC and ACA. Results:CTC were detected in all ACC but not inACAsamples. Immunocytochemistry confirmed the adrenocortical origin. When ACC patients were stratified according to the median value of tumor diameter and metastatic condition, a statistically significant difference was found in the number of CTC detected after surgery.Asignificant correlation between the number of CTC in post-surgical samples and clinical parameters was found for tumor diameter alone. Conclusions:Our findings provide the first evidence for adrenocortical tumors that CTC may represent a useful marker to support differential diagnosis between ACC and ACA. The correlation with some clinical parameters suggests a possible relevance of CTC analysis for prognosis and non-invasive monitoring of disease progression and drug response.