The diagnostic significance of reticulin stain in biopsy of adrenocortical carcinoma

  • Suhua Wu
  • Wanlin Tan
  • Ping Yang
  • Yijun Zhang
  • Mayan Huang
  • Yun Cao Sun-Yat-sen university cancer center



To investigate the diagnostic significance of reticulin stain in biopsy of adrenocortical carcinoma.

Methods and results

21 cases of adrenal mass biopsy specimens collected at Sun Yat-sen University Cancer Center from November 2008 to July 2021 which included 19 cases of adrenal cortical carcinoma (ACC) and 2 cases of normal adrenal cortical were evaluated for their histologic,immunohistochemical(IHC)and reticulin stain features, and relevant literature was reviewed. The nuclei of ACC cancer cells were deeply stained, varying in size. Varying degrees of nuclear atypia, mitotic figures, focal necrosis and tumor giant cells were visible in ACC. Most of the cytoplasm was eosinophilic, some of the cytoplasm was transparent and the ACC cancer cells were nested, cord-like or diffuse distribution. In contrast, 2 cases of normal adrenal cortex puncture tissues showed that the cytoplasm of adrenal cortex cells was partially transparent, partly eosinophilic, with small nuclei and no atypia. Among ACC patients, 4 cases (4/19) were positive for CK. 6 cases (6/19) were positive for Vimentin. 8 cases (8/19) were positive for Inhibin-a, and 7 cases (7/19) were Melan-A positive. 7 patients (7/19) were positive for SF-1. 11 patients (11/19) were Syn positive and 4 patients (4/19) were CD56 positive. The Ki-67 index of the patients ranged from 2% to 90%. The reticulin stain of 2 cases of normal adrenal cortex showed that the reticular fibers were arranged regularly and completely wrapped the adrenal cortex cell. In the reticulin stain, a complete reticular fiber appeared, and the thickness of the fiber was moderate and uniform. In 19 cases of ACC, the reticular fiber was incomplete and damaged (19/19), mainly manifested as discontinuity, breakage, disorder, sparseness or disappearance.


Reticulin stain was an effective method for accurate diagnosis of adrenal cortical carcinoma.


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1. Kamilaris CDC, Hannah-Shmouni F, Stratakis CA. Adrenocortical tumorigenesis: Lessons from genetics. BEST PRACT RES CL EN 2020;34;101428.
2. Mizdrak M, Tičinović Kurir T, Božić J. The Role of Biomarkers in Adrenocortical Carcinoma: A Review of Current Evidence and Future Perspectives. Biomedicines 2021;9;174.
3. De Filpo G, Mannelli M, Canu L. Adrenocortical carcinoma: current treatment options. CURR OPIN ONCOL 2021;33;16-22.
4. Cheng Y, Kou W, Zhu D, Yu X, Zhu Y. Future Directions in Diagnosis, Prognosis and Disease Monitoring of Adrenocortical Carcinoma: Novel Non-Invasive Biomarkers. FRONT ENDOCRINOL 2022;12.
5. Williams AR, Hammer GD, Else T. Transcutaneous biopsy of adrenocortical carcinoma is rarely helpful in diagnosis, potentially harmful, but does not affect patient outcome. EUR J ENDOCRINOL 2014;170;829-835.
6. Wanis KN, Kanthan R. Diagnostic and prognostic features in adrenocortical carcinoma: a single institution case series and review of the literature. WORLD J SURG ONCOL 2015;13.
7. Papotti M, Libè R, Duregon E, Volante M, Bertherat J, Tissier F. The Weiss Score and Beyond—Histopathology for Adrenocortical Carcinoma. Hormones and Cancer 2011;2;333-340.
8. Schmitt A, Saremaslani P, Schmid S et al.. IGFII and MIB1 immunohistochemistry is helpful for the differentiation of benign from malignant adrenocortical tumours. HISTOPATHOLOGY 2006;49;298-307.
9. Volante M, Bollito E, Sperone P et al.. Clinicopathological study of a series of 92 adrenocortical carcinomas: from a proposal of simplified diagnostic algorithm to prognostic stratification. HISTOPATHOLOGY 2009;55;535-543.
10. Duregon E, Fassina A, Volante M et al.. The reticulin algorithm for adrenocortical tumor diagnosis: a multicentric validation study on 245 unpublished cases. AM J SURG PATHOL 2013;37;1433-1440.
11. Velasco ME, Sindely SO, Roessmann U. Reticulum stain for frozen-section diagnosis of pituitary adenomas. Technical note. J NEUROSURG 1977;46;548.
12. Noh S, Kim SH, Cho NH, Kim SH. Rapid Reticulin Fiber Staining Method is Helpful for the Diagnosis of Pituitary Adenoma in Frozen Section. ENDOCR PATHOL 2015;26;178-184.
13. Kuşku Çabuk F, Sar M, Canoğlu D, Dural C, Güneş ME. Reticulin staining pattern in the differential diagnosis of benign parathyroid lesions. J ENDOCRINOL INVEST 2020;43;1571-1576.
How to Cite
WU, Suhua et al. The diagnostic significance of reticulin stain in biopsy of adrenocortical carcinoma. Diagnostic Pathology, [S.l.], v. 7, n. 1, july 2022. ISSN 2364-4893. Available at: <>. Date accessed: 15 aug. 2022. doi: