Adrenocortical carcinoma

Case contributed by Dr Arshdeep Sidhu

Presentation

Rapid weight gain, menstrual irregularity, irritability, and weakness

Patient Data

Age: 40
Gender: Female
CT

CT without contrast demonstrates a large left adrenal mass with heterogenous attenuation, and calcification.  The liver mass in the right hepatic lobe is also shown here, but demonstrates hypoattenuation. 

CT with contrast demonstrates a large left adrenal mass with heterogenous attenuation.  A large enhancing mass is also demonstrated in segments 5-8 of the right hepatic lobe, with heterogenous attenuation.  Multiple small focal heterogenous lesions are also present throughout the remainder of the liver. 

Case Discussion

Adrenocortical carcinomas are large (~10 cm) masses that commonly present with hypervascularity, and foci of hemorrhage and necrosis 1; demonstrated as a grossly heterogeneously attenuating mass.  Peak incidence is in the first and fourth decades of life, and more than half of these masses are hormonally functional 1.  As a result, another diagnostic clue is atrophy of the contralateral adrenal gland owning to the hyper functionality of the tumour.  These large masses also tend to displace surrounding organs such as the pancreas, and kidneys. 

Liver is the most common site of metastasis 2. Other sites include lung and lymph nodes (i.e. lymphangitic carcinomatosis), and direct local extension.  Inferior vena caval invasion is well-known complication as well (more commonly seen with right sided masses), with the most common location being in the suprahepatic IVC.  In these cases, patients may present with constitutional symptoms, hormonal syndromes, abdominal pain, lower extremity edema, and pulmonary emboli

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Case information

rID: 22048
Case created: 7th Mar 2013
Last edited: 21st Feb 2017
Inclusion in quiz mode: Included

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