Diagnostic Criteria Adrenal Cortical Carcinoma

• Atypical Mitoses

• High Mitotic Rate: 5 per 50 high-power fields

• High Nuclear Grade: Fuhrman grade 3 to 4; on a scale from 1 to 4, with grade 1 indicating the best prognosis and grade 4 the worst

• Absence of Cells with Clear Cytoplasm: <25 percent of the cells

• Necrosis

• Diffuse Growth Pattern: More than one third of the tumor

• Venous Invasion

• Sinusoidal Invasion

• Capsular Invasion

• If three or more of these histiologic features are present, a diagnosis of adrenal cortical carcinoma is made, whereas adrenal cortical adenomas contain two or fewer of these histologic features.