INSM1 and adrenal cortex carcinoma: Figure 4a–d shows the application of INSM1 in adrenocortical carcinoma. Awareness of its positive staining can help prevent misdiagnosing adrenocortical carcinoma as a metastasized neuroendocrine carcinoma or as an extremely rare primary small cell neuroendocrine carcinoma of the adrenal gland [79].