Adrenal gland and paraganglia
Adrenocortical adenoma and related entities
Myxoid variant

Topic Completed: 1 April 2014

Revised: 4 June 2019

Copyright: 2003-2019,, Inc.

PubMed Search: Adrenocortical adenoma myxoid

Carmen Perrino, M.D.
Debra Zynger, M.D.
Page views in 2018: 452
Page views in 2019 to date: 243
Cite this page: Perrino C. Adrenocortical adenoma - myxoid variant. website. Accessed August 18th, 2019.
Definition / general
  • Adrenal cortical adenoma (ACA) with ≥10% myxoid area
  • Most reported cases are adrenal cortical carcinomas (ACC) (Virchows Arch 2012;460:9)
  • Adrenal cortex, all 3 layers
  • Origin of myxoid areas unknown
Clinical features
  • ACA with ≥10% myxoid area
  • Depends on if the tumor is functional, and what hormones it secretes (see ACA General)
Radiology description
Prognostic factors
  • Of note, myxoid changes more common in adrenocortical carcinoma
  • Weiss Criteria (see ACA General), although may not be as reliable in myxoid tumors
Case reports
Gross description
  • Size and weight similar to ACA (generally <100 grams, <7.5 cm) (Am J Surg Pathol 2000;24:396)
  • Cut surface has some gray, gelatinous areas consistent with myxoid areas
Microscopic (histologic) description
  • Clusters of tumor cells floating in acellular, myxoid background
  • Myxoid areas ranges from 10% to >90%
  • Foci of conventional ACA cells, with tumor cells arranged in cords, trabeculae, nests, pseudo-glands (nests with central lumen filled with myxoid matrix)
Microscopic (histologic) images

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H&E and stains

Cytology description
  • Loose aggregates of pale, large, round to oval cells with delicate vacuolated cytoplasm, centrally located nuclei, a single nucleoli, and extracellular myxoid material (Diagn Cytopathol 2008;36:576)
  • Extracellular myxoid material is highlighted with Alcian blue, digested by hyaluronidase, and is PAS+ (Diagn Cytopathol 2008;36:576)
Positive stains
  • Myxoid component: Alcian blue
  • Tumor cells: synaptophysin, inhibin, vimentin
Negative stains
  • Myxoid component (negative or focally weak): PAS, mucicarmine
  • Tumor cells: cytokeratin
Electron microscopy description
  • Very few cases reported, not specifically studied
Molecular / cytogenetics description
  • Very few cases reported, not specifically studied
Differential diagnosis
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