Adrenal carcinoma

Synonyms : Adrenocortical carcinoma; adrenal cancer

Definition : Rare, aggressive tumor arising from adrenal cortex, often with local invasion and distant metastases

Ultrasound may be used for initial screening in patients with abdominal pain but offers limited ability to characterize or differentiate from other adrenal masses

Large masses; average size: 9 cm; 70% > 6 cm

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  Heterogeneous, hypoechoic/anechoic areas (necrosis &/or hemorrhage)

  
  
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  Echogenic solid components; ± calcification

  
  
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  Local invasion: Inferior vena cava, kidney, liver

Small tumors: Homogeneous, hypoechoic, similar to renal cortex

Functioning tumors usually smaller (≤ 5 cm) than nonfunctioning tumors (≥ 10 cm) at presentation

Invasion/occlusion of adrenal vein, renal vein, and inferior vena cava; ± intraluminal tumor thrombus

Best imaging tool: CECT or CEMR

Pheochromocytoma

Adrenal metastases

Neuroblastoma (in children)

Adrenal hemorrhage

Adrenal lymphoma

Other adrenal tumors complicated by hemorrhage

Myelolipoma with hemorrhage

Ganglioneuroma

Infection

Adrenal hemangioma

Rare, aggressive tumor arising from adrenal cortex, often with local invasion

Metastases to regional lymph nodes, liver, lung, bone

Rare: < 0.2% of all cancers, slightly more common in women

Bimodal distribution: < 5 years old (1st peak) and 30-50 years old (2nd peak)

Associated syndromes: Cushing, female virilization, Conn, male feminization

Definitive treatment (all stages): En bloc resection

Rule out other more common diagnoses, e.g., adenoma, hemorrhage, neuroblastoma in child

Inferior vena cava invasion (best depicted on MR) is crucial for surgical planning