The Spectrum of Large Adrenal Masses: A Case Series

Overview

Journal HCA Healthc J Med

Specialty Health Services

Date 2023 Jul 10

PMID 37425246

Authors

Jo Cooke-Barber

Sarah E Hatef

Analise McGreal

Andrew Schwemmer

Christopher Senkowski

Affiliations

Soon will be listed here.

Abstract

Background: Adrenocortical carcinoma (ACC) is a rare malignancy that is challenging to diagnose and has important implications for surgeons who approach this disease. Despite its rarity, it must always be in the differential diagnosis when investigating and treating large adrenal masses. We aim to demonstrate the complexities of this disease through a review of five recent patients at a single tertiary care center.

Methods: A series of five patients are described, each of whom presented to a single institution as referrals for "large adrenal mass" in the past sixteen months. Their pre-operative diagnosis, radiographic findings, the operative approach and the pathology results were examined.

Results: The first patient had a 12 cm high grade adrenocortical carcinoma. The second patient had pathology consistent with a 9 cm, high grade ACC. The third had a liposarcoma. The fourth patient had a myelolipoma. The fifth was diagnosed with a benign process.

Conclusion: Although adrenocortical carcinoma is an uncommon cancer, it has significant implications for the patient's prognosis and ultimately, their treatment algorithm. Therefore, when evaluating large adrenal masses, surgeons must remain vigilant of the possibility of adrenocortical carcinoma.

References

Berruti A, Baudin E, Gelderblom H, Haak H, Porpiglia F, Fassnacht M . Adrenal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012; 23 Suppl 7:vii131-8. DOI: 10.1093/annonc/mds231. View

Gonzalez R, Shapiro S, Sarlis N, Vassilopoulou-Sellin R, Perrier N, Evans D . Laparoscopic resection of adrenal cortical carcinoma: a cautionary note. Surgery. 2005; 138(6):1078-85. DOI: 10.1016/j.surg.2005.09.012. View

Shenoy V, Thota A, Shankar R, Desai M . Adrenal myelolipoma: Controversies in its management. Indian J Urol. 2015; 31(2):94-101. PMC: 4397562. DOI: 10.4103/0970-1591.152807. View

Leboulleux S, Deandreis D, Al Ghuzlan A, Auperin A, Goere D, Dromain C . Adrenocortical carcinoma: is the surgical approach a risk factor of peritoneal carcinomatosis?. Eur J Endocrinol. 2010; 162(6):1147-53. DOI: 10.1530/EJE-09-1096. View

Young Jr W . Conventional imaging in adrenocortical carcinoma: update and perspectives. Horm Cancer. 2011; 2(6):341-7. PMC: 10358061. DOI: 10.1007/s12672-011-0089-z. View

Ozsari L, Kutahyalioglu M, Elsayes K, Vicens R, Sircar K, Jazaerly T . Preexisting adrenal masses in patients with adrenocortical carcinoma: clinical and radiological factors contributing to delayed diagnosis. Endocrine. 2015; 51(2):351-9. DOI: 10.1007/s12020-015-0694-7. View

Fowler A, Burda J, Kim S . Adrenal artery embolization: anatomy, indications, and technical considerations. AJR Am J Roentgenol. 2013; 201(1):190-201. DOI: 10.2214/AJR.12.9507. View

Takeuchi S, Balachandran A, Habra M, Phan A, Bassett Jr R, Macapinlac H . Impact of ¹⁸F-FDG PET/CT on the management of adrenocortical carcinoma: analysis of 106 patients. Eur J Nucl Med Mol Imaging. 2014; 41(11):2066-73. DOI: 10.1007/s00259-014-2834-3. View

Li L, Yang G, Zhao L, Dou J, Gu W, Lv Z . Baseline Demographic and Clinical Characteristics of Patients with Adrenal Incidentaloma from a Single Center in China: A Survey. Int J Endocrinol. 2017; 2017:3093290. PMC: 5564109. DOI: 10.1155/2017/3093290. View

10.

Heron E, Chatellier G, Billaud E, Foos E, Plouin P . The urinary metanephrine-to-creatinine ratio for the diagnosis of pheochromocytoma. Ann Intern Med. 1996; 125(4):300-3. DOI: 10.7326/0003-4819-125-4-199608150-00008. View

11.

Autorino R, Bove P, De Sio M, Miano R, Micali S, Cindolo L . Open Versus Laparoscopic Adrenalectomy for Adrenocortical Carcinoma: A Meta-analysis of Surgical and Oncological Outcomes. Ann Surg Oncol. 2015; 23(4):1195-202. DOI: 10.1245/s10434-015-4900-x. View

12.

Ayala-Ramirez M, Jasim S, Feng L, Ejaz S, Deniz F, Busaidy N . Adrenocortical carcinoma: clinical outcomes and prognosis of 330 patients at a tertiary care center. Eur J Endocrinol. 2013; 169(6):891-899. PMC: 4441210. DOI: 10.1530/EJE-13-0519. View

13.

Elsayes K, Mukundan G, Narra V, Lewis Jr J, Shirkhoda A, Farooki A . Adrenal masses: mr imaging features with pathologic correlation. Radiographics. 2004; 24 Suppl 1:S73-86. DOI: 10.1148/rg.24si045514. View

14.

Boland G, Dwamena B, Jagtiani Sangwaiya M, Goehler A, Blake M, Hahn P . Characterization of adrenal masses by using FDG PET: a systematic review and meta-analysis of diagnostic test performance. Radiology. 2011; 259(1):117-26. DOI: 10.1148/radiol.11100569. View

15.

Bilimoria K, Shen W, Elaraj D, Bentrem D, Winchester D, Kebebew E . Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors. Cancer. 2008; 113(11):3130-6. DOI: 10.1002/cncr.23886. View

16.

. NIH state-of-the-science statement on management of the clinically inapparent adrenal mass ("incidentaloma"). NIH Consens State Sci Statements. 2004; 19(2):1-25. View

17.

Creemers S, Hofland L, Korpershoek E, Franssen G, van Kemenade F, de Herder W . Future directions in the diagnosis and medical treatment of adrenocortical carcinoma. Endocr Relat Cancer. 2015; 23(1):R43-69. DOI: 10.1530/ERC-15-0452. View

18.

Payabyab E, Balasubramaniam S, Edgerly M, Velarde M, Merino M, Venkatesan A . Adrenocortical Cancer: A Molecularly Complex Disease Where Surgery Matters. Clin Cancer Res. 2016; 22(20):4989-5000. DOI: 10.1158/1078-0432.CCR-16-1570. View

19.

Sturgeon C, Shen W, Clark O, Duh Q, Kebebew E . Risk assessment in 457 adrenal cortical carcinomas: how much does tumor size predict the likelihood of malignancy?. J Am Coll Surg. 2006; 202(3):423-30. DOI: 10.1016/j.jamcollsurg.2005.11.005. View

20.

Allolio B, Fassnacht M . Clinical review: Adrenocortical carcinoma: clinical update. J Clin Endocrinol Metab. 2006; 91(6):2027-37. DOI: 10.1210/jc.2005-2639. View