Association

 Carney complex (Cushing disease,spotty cutaneous pigmentation, cutaneous and cardiac myxomas, growth hormone secreting pituitary adenomas, psammomatous melanotic schwannomas, multiple myxoid fibroadenomas of breast in females, large cell calcifying Sertoli tumors of testis in males)

Macroscopy

 variable sized adrenal glands with multiple brown-black pigmented cortical nodules

Microscopy

 sharply circumscribed nodules composed of eosinophilic lipid-poor cells similar to normal zone reticularis
 growth pattern: trabecular
 prominent lipofuscin deposits in zona fasciculata
 focal necrosis
 mitotic activity

Etiology

 mutations in the PRKAR1A gene coding for the cyclic AMP-dependent protein kinase A (PKA) regulatory subunit 1A (#12424709#)