Interestingly, a pediatric ACC series from IPACTR with important differences in relation to our study (e.g., higher mean age, higher frequency of Cushing signs, lower frequency of virilization, absence of TP53 germline mutations, inclusion of adenomas, and differences in disease-free survival) reported a significant association between high Ki-67 expression and worse prognosis [22]. The gene discussed is TP53; the disease is adrenal cortex carcinoma.