“…A total of 29 cases of secondary malignancies/neoplasia were described [ 7 , 40 , 48 , 60 , 61 , 66 , 74 , 79 , 84 , 92 ], including the following entities: astrocytoma ( n = 4), osteosarcoma ( n = 3), liposarcoma ( n = 2), hepatoblastoma, chondrosarcoma, amelanotic melanoma, non-Hodgkin lymphoma, optic nerve glioma, kidney cell carcinoma, contralateral ACC, and choroid plexus papilloma ( n = 1 each), as well as lipoma ( n = 3) and hemangioma ( n = 2) as benign neoplasias. Even if there are only sporadic reports, nationwide analyses and genomic profiles [ 11 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 ] hypothesize that the number of CPSs may be much higher than thought, and genetic counseling should be recommended to all parents and legal guardians of pediatric patients with ACC.…”