Axial CT image shows a 5-cm heterogeneous left adrenal mass (arrows) with ill-defined border anterolaterally, and a liver mass (arrowhead).
Facts: Adrenal Cortical Carcinoma (ACC)
- Rare tumor, 0.5 to 2 cases per million population
- Bimodal age peak - young children, and adults in 4th to 5th decades
- Male = female
- Tumor arises from adrenal cortex; 50% produces hormones (cortisol, androgens)
- Most common site of metastasis: liver and lung
Adrenal Masses: Size Matters
- Mass less than 2 cm: incidence of malignancy 1%
- 2-4 cm: 3% - 8%
- 4-6 cm: 8% - 25%
- Greater than 6 cm: 40% - 80%
- CT or MRI can suggest the diagnosis if there is malignant feature: venous invasion and/or capsular invasion, metastasis to lymph nodes or other organs.
- Mass usually is large, 70% of ACC are larger than 6 cm on imaging
- Usually heterogeneous after contrast administration
- 30% are calcified (usually central)
- Enlarged lymph nodes seen in 1/3 of cases (usually at high para-aortic or paracaval)
- MRI may be used as an adjunct to CT for delineation of IVC invasion and extension
Our case: adrenal cortical carcinoma
1. DeVita VT, et al. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology, 8th edition, 2008
2. Husband JE, Reznek RH. Imaging in Oncology, Volume 1, 2nd edition, 2004.