Adrenocortical Neoplasms

Neoplasms of the adrenal cortex are relatively common, with many being detected as incidental findings on imaging studies performed for unrelated clinical conditions. The majority of adrenocortical tumors are benign adenomas, while carcinomas of the adrenal cortex are rare. The diagnostic distinction between adrenocortical adenoma and carcinoma can be problematic. Histologic criteria have been delineated that allow separation of benign from malignant adrenocortical tumors. Several multiparametric systems for evaluating adrenocortical tumors have been effective in making this distinction in adults. Pathologic criteria for establishing a diagnosis of malignancy in adrenocortical neoplasms arising in the pediatric population, however, remain controversial. On occasion, the differentiation of adrenocortical tumors from medullary lesions and metastases can be difficult based on morphologic findings alone. Immunohistochemical studies can resolve this problem in most instances. These issues pertaining to the pathology of tumors of the adrenal cortex are discussed in this review.