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Adrenocortical Carcinoma
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- Clinical: male = female; 50% with hormonal manifestations; average age is 50 yrs.
- Gross: weight usually > 100 g; cut surface is variegated with hemorrhage and necrosis
- Histologic features: The diagnosis of malignancy is definitively established when metastatic disease is discovered; however, there are some features of the adrenal lesion that favor a malignancy process. They are:
- size > 5 cm, weight > 100 grams.
- significant nuclear pleomorphism
- mitoses > 5 /50 high power field
- paucity or absence of clear cells
- diffuse architecture
- capsular invasion, vascular invasion, or necrosis
- spindled cells
Remember: nothing short of detecting metastases definitively establishes malignancy.
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