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# Adrenocortical adenoma and carcinoma

- Lesion

Adrenal lumps are often found by chance on scans. Most are small harmless adenomas; large ones may be cancer.

Updated Nov 12, 2026

## Key points

- Adenoma: well circumscribed, yellow, usually small; most are non-functioning.
- Cortisol-secreting adenoma: atrophy of the adjacent and contralateral cortex; aldosterone-secreting: no atrophy.
- Carcinoma: large, invasive, necrotic, haemorrhagic; often functioning (virilisation); invades adrenal vein and cava; bimodal age.
- Genetics of carcinoma: Li-Fraumeni (TP53), Beckwith-Wiedemann (IGF2 overexpression), also MEN1 and Lynch.
- Metastases (lung, breast, melanoma) outnumber primary carcinoma; immunostains separate them.
- Myelolipoma: benign mixture of mature fat and haematopoietic cells; cysts are usually pseudocysts after haemorrhage.

## What it is

Adrenocortical neoplasms range from small, common, non-functioning adenomas to rare, aggressive carcinomas. Functioning tumours cause Cushing syndrome, hyperaldosteronism or virilisation. Because modern imaging finds adrenal masses in a few percent of adults, the incidentaloma is a frequent clinical problem: the questions are whether it secretes hormones and whether it could be malignant. Metastases to the adrenal are more common than primary carcinoma.

## Structure

- Adenoma: lipid-rich, clear to eosinophilic cells resembling fasciculata; mild nuclear variation; thin capsule.
- Carcinoma: diffuse sheets, necrosis, high mitotic rate, atypical mitoses, capsular and venous invasion; scoring systems combine these features.
- Carcinoma cells express SF1, inhibin, Melan-A and calretinin and lack the epithelial markers typical of metastatic carcinoma.
- Myelolipoma: fat with erythroid, myeloid and megakaryocytic precursors.
- Pseudocyst: fibrous wall without epithelium, old blood.

## Adrenal masses compared

| Lesion | Size and look | Hormones | Behaviour |
| --- | --- | --- | --- |
| [Adenoma](https://durgical.com/en/conditions/adrenal-incidentaloma/) | Small, yellow, lipid-rich | Usually none; sometimes cortisol or aldosterone | Benign |
| [Carcinoma](https://durgical.com/en/conditions/adrenocortical-carcinoma/) | Large, variegated, necrotic | Often cortisol and androgens | Aggressive, invades veins |
| [Metastasis](https://durgical.com/en/conditions/lung-cancer/) | Often bilateral | None (can cause insufficiency) | Depends on primary |
| [Pheochromocytoma](https://durgical.com/en/conditions/phaeochromocytoma/) | Grey-brown, haemorrhagic | Catecholamines | Can metastasise |
| Myelolipoma | Fat with marrow elements | None | Benign; can bleed when large |
| Cyst or pseudocyst | Fluid-filled | None | Benign |

## Clinical notes

- Every incidentaloma is tested for cortisol excess, catecholamines and, if hypertensive, aldosterone.
- Size and imaging density (lipid content) guide the risk of malignancy; larger, lipid-poor masses are suspicious.
- Mild autonomous cortisol secretion raises cardiovascular risk.

## Memory aid

The adrenal incidentaloma asks two questions: is it talking (hormones) and is it big and dark on CT (malignancy)?

## Test yourself

Think of the answer, then tap the question to see it.

## Why is the adjacent cortex atrophic next to a cortisol-secreting adenoma?

Cortisol from the tumour suppresses pituitary ACTH, so normal cortex loses its stimulus.

## Which inherited syndromes predispose to adrenocortical carcinoma?

Li-Fraumeni syndrome (TP53) and Beckwith-Wiedemann syndrome; also MEN1 and Lynch syndrome.

## What is an adrenal myelolipoma?

A benign lesion of mature fat mixed with haematopoietic cells of all lineages.

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## Elsewhere in DurgiPedia

- [Benign vs malignant tumours: the comparison table](https://durgical.com/en/general-pathology/benign-vs-malignant-tumours-the-comparison-table/)
- [Hereditary cancer syndromes: the table to know](https://durgical.com/en/general-pathology/hereditary-cancer-syndromes-the-table-to-know/)

## Connections

## Related 5

- [Cushing syndrome: causes and the adrenals](https://durgical.com/en/general-pathology/cushing-syndrome-causes-and-the-adrenals/)
- [Hyperaldosteronism: primary and secondary](https://durgical.com/en/general-pathology/hyperaldosteronism-primary-and-secondary/)
- [Pheochromocytoma and paraganglioma](https://durgical.com/en/general-pathology/pheochromocytoma-and-paraganglioma/)
- [Hereditary cancer syndromes: the table to know](https://durgical.com/en/general-pathology/hereditary-cancer-syndromes-the-table-to-know/)
- [Pathways of spread and the usual metastatic sites](https://durgical.com/en/general-pathology/pathways-of-spread-and-the-usual-metastatic-sites/)

## Related conditions 6

- [Adrenocortical carcinoma](https://durgical.com/en/conditions/adrenocortical-carcinoma/)
- [Adrenal incidentaloma](https://durgical.com/en/conditions/adrenal-incidentaloma/)
- [Cushing syndrome](https://durgical.com/en/conditions/cushing-syndrome/)
- [Primary hyperaldosteronism (Conn syndrome)](https://durgical.com/en/conditions/primary-hyperaldosteronism/)
- [Beckwith–Wiedemann syndrome](https://durgical.com/en/conditions/beckwith-wiedemann-syndrome/)
- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Adrenocortical Carcinoma Treatment (PDQ®)–Health Professional Version](https://www.cancer.gov/types/adrenocortical/hp/adrenocortical-treatment-pdq) (National Cancer Institute, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/adrenocortical-adenoma-and-carcinoma/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/adrenocortical-adenoma-and-carcinoma/