Assessment of Adrenal Cortical Neoplasms for the GU Pathologist

The challenging aspect of adrenal gland pathology is that adrenal cortical carcinoma is rare but is in the differential for every adrenal gland biopsy and adrenalectomy specimen. Currently, the Weiss system (for adult patients) and Wieneke criteria (for pediatric patients) remain the most widely used for diagnostic adrenal cortical pathology. More recent multiparameter systems have been developed, including those using different parameters and schemes for specific scenarios. Even so, there are caveats with each multiparameter scoring system. Also, if Ki-67 is not performed as part of a multiparameter scoring system, it should be performed as it has clinical significance in all age groups. The “eyeballing” method of interpretation of Ki-67 is discouraged. The increased understanding of the genomic landscape of adrenal cortical neoplasia may allow for better risk stratification, therapeutics, and monitoring.