Diagnostic Ultrasound - Abdomen and Pelvis

Adrenal Carcinoma
Diagnoses: Adrenal Gland
TERMINOLOGY
• Adrenal carcinoma
• Synonyms: Adrenocortical carcinoma; adrenal cancer
• Definition: Rare, aggressive tumor arising from adrenal
cortex, often with local invasion and distant metastases
IMAGING
• US may be used for initial screening in patients with
abdominal pain but offers limited ability to characterize or
differentiate from other adrenal masses
• Best imaging tool: CECT or CEMR
• Large heterogeneous necrotic adrenal mass ± calcification
venous invasion and metastases
○ Metastases to regional lymph nodes, liver, lung, bone
TOP DIFFERENTIAL DIAGNOSES
• Pheochromocytoma
• Adrenal metastases
• Adrenal adenoma
KEY FACTS
• Adrenal lymphoma
• Ganglioneuroma
• Neuroblastoma (in children)
• Myelolipoma
• Adrenal hemorrhage
CLINICAL ISSUES
• Rare: < 0.2% of all cancers
• Bimodal distribution: < 5 years old (1st peak) and 30-50
years old (2nd peak); slightly more common in women
• Associated syndromes: Cushing, female virilization, Conn,
male feminization
• Definitive treatment (all stages): En bloc resection
DIAGNOSTIC CHECKLIST
• Rule out other more common diagnoses, e.g., adenoma,
hemorrhage, neuroblastoma in child
• Inferior vena cava (IVC) invasion (best depicted on MR) is
crucial for surgical planning
(Left) Longitudinal graphic
shows a large right adrenal
carcinoma (AC) with areas
of necrosis , tumor invasion
into the IVC ſt, and
compression of the right renal
upper pole . (Right)
Longitudinal transabdominal
US demonstrates a large, welldemarcated
solid echogenic
mass . Its large size makes
adenoma less likely, but the
US appearance is otherwise
nonspecific and could
represent a variety of adrenal
masses. CT showed features
specific for AC, which was
confirmed at surgical
resection. IVC is shown ſt.
(Left) Longitudinal
transabdominal ultrasound
demonstrates a large,
heterogenous right adrenal
mass with hypoechoic
areas of necrosis ſt. Note the
radiating stellate echogenicity
and calcification st. Right
kidney is shown . (Right)
Corresponding coronal CECT
shows a large heterogenous
right adrenal mass with
internal necrosis and
intratumoral calcification.
Note invasion of the IVC .
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