Recently, the Ki-67 labeling index was reported as a reliable prognostic factor in patients with ACC.1,11–13 One recent study from the European Network for the Study of Adrenal Tumors Classification (ENSAT) group attempted risk stratification in patients with localized ACC by investigating the risk of recurrence and OS using a risk scoring system that included Ki-67 index, tumor size, and the presence of venous thrombosis.14 Here, MKI67 is linked to Venous thrombosis.