Full list of author information is available at the end of the articleAdrenocortical carcinoma (ACC) is rare and has a poor prognosis. Even for patients with resected tumors, the median survival is only 32 months in the United States . While ACC is uncommon with an annual incidence of 0.5 to 2.0 per million people, adrenal incidentalomas superior imaging techniques, with a reported prevalence of 3 % to 4 % on abdominal CT scan [1-5]. Most adrenal incidentalomas are benign, while most malignant adrenal tumors are metastatic in origin . As such, accurate diag-nosis of malignant adrenocortical tumors, particularly distinguishing ACC from adrenal adenomas, is essential for management; however, accurate diagnosis continues to remain a challenge. There are continued significant areas of uncertainty regarding pathogenesis and risk as
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