“…The p53/Rb pathway is composed of proteins that control cell cycle entry at G1 and dysregulation of these molecules is thought to lead to uncontrolled cell proliferation in ACC [ 43 , 44 ]. On the other hand, alterations in proteins of the Wnt/β-catenin-signaling pathway cause aberrant Wnt activation and affect adrenocortical cell renewal, differentiation, and proliferation [ 12 , 14 , 30 ]. Interestingly, the combination of mutations affecting both TP53 and CTNNB1 have been described in a small group of both pediatric and adult patients presenting with malignant adrenocortical tumors and correlates with poor prognosis [ 6 , 9 , 10 , 45 , 46 ], though, in general, the majority of high-risk patients do not simultaneously harbor mutations in both genes [ 47 ].…”