June 21, 2010

Adrenal Cortical Carcinoma

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%
Imaging Features
  • 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.

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