Abstract
Background : Little is known about the pathological features of pediatric adrenocortical carcinoma due to its rarity.
Cases : Five pediatric subjects had functioning adrenocortical carcinoma, four with virilization and/or Cushing syndrome. Tumors weighed 430, 33, 52, 72, and 65 grams. Cut tumor surfaces were solid and golden to red-brownish, with one containing hemorrhagic necrosis and cyst formation. Stump cytology in 4 cases showed many round tumor cells stained light-green together with eccentric nuclei and eosinophilic granules. All cases showed multinuclei, irregular nuclei, increased chromatin, prominent nuclear bodies, and increased nuclear cytoplasmic (N/C) ratios. Nuclear pyknosis and intranuclear vacuolization were also evident. Similar findings were seen histopathologically, i. e., solid eosinophilic tumor cell growth with polymorphic nuclei and hyperchromatinism. The severity of atypical mitosis, clear cell ratio, and immunohistochemistry results varied among the five cases. Electron microscopy confirmed that tumor cells were derived from the adrenal cortex.
Conclusions : Pathological findings in these cases shared common features, but individual findings varied strikingly, requiring meticulous pathological assessment for a definitive diagnosis. Special attention should be paid in cytological diagnosis to the presence of tumor cells with high N/C ratios.
