• Rare, < 20 cases reported
  
• Single mass of admixed population of adrenal cortical and medullary cells
  
• By definition, excludes simultaneously occurring adrenocortical adenomas and pheochromocytomas and ACTH-producing pheochromocytomas with associated adrenocortical hyperplasia
  
• May be a collision tumor
  
• 85% women, mean age 50 years (32-61 years)
  
• Usually present with Cushing’s syndrome that resolves after tumor excision
  
• Benign behavior
  

• 55 year old woman with Cushing’s syndrome and incidental myelolipoma (Arch Pathol Lab Med 2003;127:e329)
  

Fig 1: well circumscribed, tan-yellow tumor; normal adrenal gland at bottom; Fig 2: classic myelolipoma with hematopoietic cells and fat cells, normal adrenocortical tissue at bottom; Fig 3A: EM shows cytoplasmic granules of adrenal medullary origin (upper left) and lipid droplets of adrenal cortical origin (lower right); Fig 3B: EM shows cytoplasmic dense-core granules of adrenal medullary origin

• Mixture of medullary pheochromocytoma cells (abundant, finely granular eosinophilic cytoplasm and round / oval nuclei with coarse chromatin) and adrenocortical tumor cells (clear cytoplasm)
  

Mixture of adrenocortical cells and pheochromocytoma cells

Pheochromocytoma component with abundant finely finely granular cytoplasm and round/oval nuclei

Adrenocortical adenoma component with clear cytoplasm

Tumor thrombosis and recanalization of vascular channels

Pheochromocytoma cells are chromogranin+

Synaptophysin+

Neuron specific enolase+

Sustentacular cells are S100+

Various images

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