Adrenal cortical neoplasms producing Cushing's syndrome. A clinicopathologic study

The clinical and pathologic findings in 12 women with Cushing's syndrome due to adrenal cortical neoplasms have been reviewed. The neoplasms were classified as adenomas or adenocarcinomas on the basis of the patient's ultimate clinical course and histologic study was then made retrospectively. Those patients with an adenocarcinoma manifested more rapid progression of their disease and had a higher incidence of androgenic hirsutism and acne than did those with benign tumors. The most reliable biochemical index of malignancy was the great elevation of urinary 17‐ketosteroids in patients with an adenocarcinoma. The malignant neoplasms, at the time of operation, were uniformly larger than the benign ones. Moreover, none of the adenomas manifested hemorrhage or broad areas of recent necrosis. Capsular invasion was found to be a consistent histologic criterion of malignancy. Other reliable criteria of malignancy included increased and abnormal mitotic activity and severe nuclear pleomorphism. If adequate and representative tissue is submitted for microscopic examination, assessment of malignancy should be possible with a high degree of accuracy.