Presentation
Work up for hirsutism and infertility. Palpable abdominal mass on physical exam.
Patient Data
A 150× 70× 75 mm well-defined mass with a slightly lobulated margin is noted in the left adrenal lodge and displaces the pancreas and splenic vessels anteriorly. There is no sign of local invasion to adjacent structures. The mean attenuation values of the mass on non-contrast images measured 32 HU. After contrast media administration the mass shows heterogeneous enhancement and the mean attenuation values on PVP and delayed images measured 82 HU and 63 HU, respectively.
Case Discussion
The patient underwent left adrenal mass resection and histopathology evaluation, and IHC confirmed adrenal cortical carcinoma, a rare and highly malignant neoplasm that may present as a hormonally active lesion.
Functioning adrenal cortical carcinomas are more common in females and may cause Cushing syndrome, virilisation, feminization, or Conn syndrome.
On imaging, the masses tend to be large, with internal areas of necrosis and hemorrhage. Calcifications could be seen in up to 30% of cases.
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