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

References:

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.