Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]Ahmad Al Maradni, M.D. [3]
Overview
Adrenocortical carcinoma must be differentiated from other diseases such as adrenocortical adenoma, renal cell carcinoma, adrenal medullary tumors, and hepatocellular carcinoma.
Differentiating Adrenal Carcinoma from other Diseases
Adrenocortical carcinoma should be differentiated from:
| Differential Diagnosis
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Clinical picture
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Imagings
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Laboratory tests
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| Adrenal adenoma
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- Round and homogeneous density, smooth contour and sharp margination [15]
- Diameter less than 4 cm, unilateral location
- Low unenhanced CT attenuation values (<10 HU) (image 1)
- Rapid contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of more than 50 percent)
- Isointensity with liver on both T1 and T2 weighted MRI sequences
- Chemical shift evidence of lipid on MRI
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| Adrenocortical carcinoma
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- Mass effect symptoms; symptoms related to excess glucocorticoid, mineralocorticoid, androgen, or estrogen secretion
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- Irregular shape
- Inhomogeneous density because of central areas of low attenuation due to tumor necrosis (image 4)
- Tumor calcification
- Diameter usually >4 cm
- Unilateral location
- High unenhanced CT attenuation values (>20 HU)
- Inhomogeneous enhancement on CT with intravenous contrast
- Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
- Hypointensity compared with liver on T1 weighted MRI and high to intermediate signal intensity on T2 weighted MRI
- High standardized uptake value (SUV) on FDG-PET-CT study
- Evidence of local invasion or metastases
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- Serum DHEAS
- Measures of clinicallyindicated
- steroid
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| Cushing's syndrome
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- Imaging may show adenoma if presents
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| Pheochromocytoma
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- Increased attenuation on nonenhanced CT (>20 HU)
- Increased mass vascularity (image 2)
- Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
- High signal intensity on T2 weighted MRI (image 3)
- Cystic and hemorrhagic changes
- Variable size and may be bilateral
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| Adrenal metastasis
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- Symptoms and signs of primary malignancy especially lung cancer.
- General constitutional symptoms:
- Fever
- Fatigue
- Weight loss
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- Irregular shape and inhomogeneous nature
- Tendency to be bilateral
- High unenhanced CT attenuation values (>20 HU) and enhancement with intravenous contrast on CT
- Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
- Isointensity or slightly less intense than the liver on T1 weighted MRI and high to intermediate signal intensity on T2 weighted MRI (representing an increased water content)
- Elevated standardized uptake value on FDG-PET scan
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References