Answer: Oncocytic adrenocortical neoplasm of borderline malignant potential

Histology:

Discussion: The Weiss criteria are generally used for predicting behavior in conventional (non-oncocytic) adrenocortical tumors. A different set of morphologic criteria for predicting behavior in the oncocytic subset of adrenal tumors have been proposed by Bisceglia et al. The authors define oncocytic adrenocortical tumors as neoplasms with predominantly cells with eosinophilic and granular cytoplasm, high nuclear grade, diffuse architectural pattern. They distinguished a set of “major criteria” to include: i) high mitotic rate, ii) atypical mitoses and iii) venous invasion from remaining “Minor” criteria that included large size and weight, necrosis, capsular invasion and sinusoidal invasion. According to the proposed system, the presence of 1 major criterion indicates malignancy while the presence of 1 to 4 minor criteria indicate an uncertain malignant potential (borderline), and in the absence of any major or minor criteria the tumor should be classified as an oncocytic adenoma.

Reference(s):
– Medeiros LJ, Weiss LM. New developments in the pathologic diagnosis of adrenal
cortical neoplasms. A review. Am J Clin Pathol. 1992 Jan;97(1):73-83. Review.
PubMed PMID: 1728867.
– Bisceglia M, Ludovico O, Di Mattia A, Ben-Dor D, Sandbank J, Pasquinelli G,
Lau SK, Weiss LM. Adrenocortical oncocytic tumors: report of 10 cases and review
of the literature. Int J Surg Pathol. 2004 Jul;12(3):231-43. PubMed PMID:
15306935.