Adrenal gland & paraganglia

Adrenal cortical carcinoma

Oncocytic variant

Topic Completed: 1 September 2013

Minor changes: 16 November 2021

Copyright: 2002-2021,, Inc.

PubMed Search: Oncocytic[title] carcinoma adrenal

Pallav Gupta, M.D.
Page views in 2020: 2,575
Page views in 2021 to date: 2,373
Cite this page: Gupta P. Oncocytic variant. website. Accessed December 8th, 2021.
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 > 200 g, 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 nonfunctional
  • 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

Images hosted on other servers:

Large multinodular
yellow tumor with
central necrosis

Microscopic (histologic) 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
Microscopic (histologic) images

Contributed by Debra Zynger, M.D.

Oncocytic variant

Images hosted on other servers:

Binucleated cell with prominent nucleoli

Positive stains
  • AE1 / AE3, CAM5.2, variable inhibin
Electron microscopy description
  • Numerous mitochondria
Differential diagnosis
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