Adrenal cortical carcinoma is a malignant epithelial tumour derived from adrenal cortical cells. Symptoms depend on the hormonal secretory status of the tumour which can produce cortisol, aldosterone, androgens, estrogens, or can be non-functioning. Microscopically the tumour can show a wide spectrum of morphologies ranging from overtly malignant to minimally atypical cells that resemble normal adrenal cortex. The tumour cells can be bland to markedly pleomorphic, with clear to eosinophilic cytoplasm, and can have increased mitotic activity with variable amounts of necrosis. By immunohistochemistry, the tumour cells are typically positive for synaptophysin, calretinin, inhibin, Melan-A, and SF1. More than 50% of people with adrenocortical carcinoma have the hereditary cancer syndrome Li-Fraumeni syndrome.