Adrenal gland and paraganglia
Adrenocortical carcinoma
Oncocytic carcinoma

Author: Pallav Gupta, M.D. (see Authors page)

Revised: 18 January 2018, last major update September 2013

Copyright: (c) 2002-2018,, Inc.

PubMed Search: oncocytic[title] carcinoma adrenal

Definition / General
  • Rare variant, ~115 cases reported
  • Weiss system for malignancy not applicable because all tumors have eosinophilic tumor cytoplasm, diffuse architecture and nuclear atypia
  • Lin-Weiss-Bisceglia (LWB) system:
    • Major criteria: mitotic rate >5 mitoses per 50 high-power fields, any atypical mitoses or venous invasion
    • Minor criteria: >10 cm or >200g, necrosis, capsular invasion or sinusoidal invasion
    • Proposed working rules:
      • Malignant (oncocytic adrenocortical carcinoma): any major criteria
      • Uncertain potential (borderline oncocytic neoplasm of uncertain malignant potential): only minor criteria
      • Benign (adrenocortical oncocytoma): no major, no minor criteria
Clinical Features
  • Ages 39-71
  • Usually non-functional
  • One tumor invaded the inferior vena cava and extended into the right atrium, another metastasized to bone
Gross Description
  • Large yellow-tan tumors (8.5 to 17.0 cm), well-demarcated from adjacent kidney
  • Thin rim of normal adrenal gland
Gross Images
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Large multinodular yellow tumor with central necrosis

Micro Description
  • Diffuse proliferation of polygonal cells with abundant granular and eosinophilic cytoplasm, large nuclei and prominent nucleoli
  • Occasional mononuclear and binucleated giant cells
  • Often extracapsular extension, blood vessel invasion and necrosis
  • Variable atypia; mitotic figures
Micro Images
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Trabeculae of tumor cells

Large, polygonal and eosinophilic neoplastic cells

Tumor cells with foamy cytoplasm

Binucleated cell with prominent nucleoli



Positive Stains
  • AE1-AE3, CAM5.2, variable inhibin
Electron Microscopy Description
  • Numerous mitochondria
Electron Microscopy Images
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Prominent nucleoli

Differential Diagnosis