Fact-sheet: Adrenocortical carcinoma
Updated on 08/23/2017 at 7:11 AM
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Definition
- Malignant epithelial tumor arising from adrenal cortical cells.
- Rare tumor (0.1 to 0.2% of all cancers)
Clinical features
Varies according to whether the tumor is secreting or not.
- Nonfunctioning tumor: abdominal pain, palpable mass
- Functioning tumor: Cushing syndrome (30%), virilization syndrome, Conn syndrome
Laboratory findings
Functioning tumors: elevated blood levels of cortisol, androgens, aldosterone.
Ultrasound
- Heterogeneous soft-tissue lesion in a suprarenal position
CT
- Large, solid, rapidly growing adrenal mass,
+/- calcified (30% of cases)
- Heterogeneous enhancement, predominantly peripheral, after iodinated contrast injection.
- Possible areas of necrosis or hemorrhage.
- Look for tumor extension into the inferior vena cava
+/- hematogenous metastases = adrenocortical carcinoma.
- Metastatic sites: lung, liver, kidney, brain
MRI
- Suprarenal lesion
- Frequent T1 hyperintensity (hemorrhagic changes)
- Mixed T2 hyperintensity (tumor + necrotic fluid)
- Heterogeneous enhancement, predominantly peripheral
Nuclear medicine
- Very high-intensity uptake, predominantly peripheral within the lesion
Management
- Surgical resection extended to the kidney
- Neoadjuvant chemotherapy if metastases are present
Differential diagnosis
- Adrenocortical adenoma
- Metastases to adrenal gland
- Adrenal myelolipoma
- Pheochromocytoma
- Clear cell carcinoma of the upper pole of the kidney