Background: Adrenocortical tumors (ACTs) are exceedingly rare in children. The Wieneke scoring system is commonly used for malignancy classification; however, the prognostic role of immune checkpoint markers, particularly programmed death-ligand 1 (PD-L1), remains uncertain. Given the emerging role of immune checkpoints in cancer progression, this study evaluates PD-L1 expression in pediatric ACTs and its correlation with clinical outcomes. Procedure: A retrospective review was conducted on 23 pediatric ACT patients diagnosed between 2000 and 2020. Clinical, pathological, and immunohistochemical data were analyzed. Tumor samples were stained for PD-L1 using immunohistochemistry, with a positivity threshold set at ≥3%. Malignancy classification was performed using the Wieneke scoring system, and correlations between PD-L1 expression, malignancy classification, and patient outcomes were assessed. Results: Among the 23 patients, 12 had adrenocortical carcinoma (ACC) and 11 had adrenocortical adenoma (ACA). PD-L1 positivity was observed in three patients: one with ACA and two with ACC. One patient demonstrated PD-L1 positivity in both primary and metastatic tumor samples. Wieneke scoring classified 11 patients as malignant, one as intermediate, and 11 as benign. No significant correlation was found between PD-L1 expression and Wieneke scores. Conclusions: Although PD-L1 expression was more frequent in ACC cases, it did not demonstrate a significant prognostic impact. This finding aligns with broader variations in PD-L1 significance across different cancers. While immune checkpoint markers are implicated in tumor progression, their role in pediatric ACT remains unclear. Further multi-center studies are required to determine their prognostic relevance and therapeutic potential, particularly in the context of immunotherapy.