The authors investigated expression of PD-L1 and V-domain Ig-containing suppressor of T cell activation (VISTA) in ACC and their associations with clinicopathological features and survival outcomes. They report that a higher VISTA expression intensity, a larger area, and a higher immunoscore were associated with increased risks of disease progression and overall mortality. However, PD-L1 expression in tumor cells or tumor-infiltrating immune cells was not associated with OS or DFS. The study points to the potential value of VISTA, in addition to PD-L1, as an immunotherapeutic target in ACC.