Review ArticlesApproach to Fine Needle Aspiration of Adrenal Gland LesionsCantley, Richard L. MD Author Information Department of Pathology and Clinical Laboratories, University of Michigan-Michigan Medicine, Ann Arbor, MI The author has no funding or conflicts of interest to disclose. All figures can be viewed online in color at www.anatomicpathology.com. Reprints: Richard L. Cantley, MD, Department of Pathology and Clinical Laboratories, University of Michigan-Michigan Medicine, Faculty Suite Rm. 36-1221-30, 2800 Plymouth Rd, Building 35, Ann Arbor, MI 48109 - 2800 (e-mail: [email protected]). Advances In Anatomic Pathology: November 2022 - Volume 29 - Issue 6 - p 373-379 doi: 10.1097/PAP.0000000000000356 Buy Metrics Abstract Adrenal gland lesions are present in 1% to 5% of patients and are most commonly identified incidentally on abdominal imaging. Fine needle aspiration (FNA) cytology plays an important role in the initial workup of adrenal gland nodules, especially in patients with a known history of malignancy. The most common reason for adrenal gland FNA is to differentiate benign adrenal lesions, such as adrenal cortical adenoma, from metastatic malignancy. However, there is a significant cytomorphologic overlap between primary and metastatic adrenal neoplasms. This review focuses on the current state of adrenal gland FNA cytology, with an emphasis on distinguishing adrenocortical adenoma from carcinoma and adrenal cortical neoplasms from metastatic malignancies. The role of immunohistochemistry in specifically diagnosing adrenal neoplasms is discussed. Proposed diagnostic classification systems for adrenal gland FNA cytology are also described. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.