Fig. 2

Representative histological pictures – Immunohistochemistry patterns of the three adrenocortical carcinomas. Case 1. Adrenocortical carcinoma composed of trabeculae and cords of medium cells with eosinophilic cytoplasm dispersed within myxoid stroma (panel A, H&E, 5x). The tumour was negative to Melan A (panel B, Melan A, 10x). Slides were imaged with the Leica Aperio Versa brightfield scanning microscope (Leica Biosystems, Wetzlar, Germany) and pictures were obtained using the Aperio ImageScope software (Leica Biosystems). Scale bar = 200 μm and 10 μm, respectively. Case 2. Adrenocortical carcinoma with blastematous histological features. The neoplasm revealed extra-adrenal extension, venous vascular invasion (panel A, H&E 12.5x), high nuclear/cytoplasmic ratio with confluent necrosis (panel B, H&E, 100x), frequent mitotic figures (panel C, H&E 200x), and numerous atypical mitoses (panel D, H&E 400x). The images were acquired using the ZEN core software (version 3.1). The minimal resolution was 1.375 μm for 4x magnification, 0.61 for 10x, 0.37 for 20x, and 0.29 for 40x. Scale bar = 2 mm, 200 μm, 100 μm and 50 μm, respectively. Case 3. Adrenocortical carcinoma with infiltration of the liver. The microscopic report described a diffuse tumour architecture with necrosis, tumour cells with a high nuclear grade, mitotic count of > 20 mitoses/50 HPF, atypical mitotic figure, sinusoidal, vascular, and capsular invasion. H&E slides were imaged with the Leica Aperio Versa brightfield scanning microscope (Leica Biosystems, Wetzlar, Germany) and picture were obtained using the Aperio ImageScope software (Leica Biosystems) with 10x (panel A) and 20x (panel B) enlargement. Scale bar = 200 μm. All the images have been acquired without filters, additional processing, or adjustment for size or color