Ranathunga DS, et al. - Three case reports and one retrospective study including a total of seven cases of adrenocortical carcinoma (ACC) were involved in order to ascertain the number and quality of reports of ACC containing macroscopic fat and this information could notify guidelines for diagnosis and management of ACC. Few reports of macroscopic fat in ACC discovered on imaging studies were there and in the reports of macroscopic fat in ACC, tumors were large (> 6 cm) and had a small part of gross fat (< 5%). The reliability of reported cases is contentious mainly due to inadequate details about pathologic diagnosis. On the basis of this information, a variation in guideline recommendations might not be assured. Nevertheless, consideration of follow-up or biopsy of individuals with large symptomatic tumors (> 6 cm) having a small part of fat (< 5%) could be relevant.