The College cautions that any uses of the protocol for these purposes involve considerations that are beyond the scope of this document. Incompletely removed hyperplastic adrenal tissue may re-grow if previously incompletely excised. Severe nuclear atypia, high mitotic count, vascular invasion, tumor necrosis, and other microscopic features may, in combination, support a diagnosis of adrenal cortical carcinoma over adenoma and should be recorded , but no precise clustering of histologic features is considered diagnostic of malignancy. Pheochromocytoma is usually diagnosed preoperatively by pharmacologic means. No pathologic criteria for differentiation of benign from malignant pheos have been defined.
Metastatic disease is considered the only irrefutable proof of malignancy.
An entire adrenal tumor may be removed laparoscopically, but with this technique, the gland may become fragmented. This anatomic information, including maximal diameter of the resected tumor, should be provided by the surgeon. Although tumor mass cannot be used as the sole criterion for malignancy, adrenal cortical neoplasms weighing less than 50 grams are almost always benign, whereas the weight of malignant tumors is usually greater than 100 grams. Shapiro B. Incidentally discovered adrenal masses. A mathematical analysis of clinical and morphologic data.