title: Large degenerated adrenal adenomas: radiologic-pathologic correlation.
abstract: OBJECTIVE
  To correlate the radiologic and pathologic findings and differential diagnosis of large, degenerated adrenal adenomas.
  
  
  METHODS
  The authors reviewed the radiologic and pathologic characteristics of 30 large adenomas with cystic regions or areas of heterogeneity that were either intrinsic or demonstrated at contrast material-enhanced computed tomography (CT) or magnetic resonance (MR) imaging. Images of 24 adrenocortical carcinomas were also reviewed to determine whether differentiating characteristics existed.
  
  
  RESULTS
  Most of the adrenocortical adenomas were in asymptomatic women. Ten adenomas contained calcification. Pathologic examination revealed good correlation between heterogeneity and liquefied regions. Histologic examination confirmed regions of adenomatous tissue with areas of hemorrhage, amorphous degenerated material, calcification, and fibrosis. Some tumors contained myelolipomatous foci. Although some clinical and imaging findings differed between the groups, no features could be found that enabled the radiologic differentiation of adenomas from carcinomas.
  
  
  CONCLUSIONS
  A subgroup of adrenal adenomas are larger, more heterogeneous, and more frequently calcified than those with the usual imaging findings. Central necrosis, hemorrhage, or both are responsible for many of the imaging features. Differentiation of these lesions from other large adrenal masses, including adrenal carcinoma, cannot be made by means of imaging alone; resection is required for the definitive diagnosis.
authors: Department of Radiology, Armed Forces Institute of Pathology, Washington, DC, USA.
authors: J H
authors: JH
authors: Newhouse
authors: C S
authors: CS
authors: Heffess
authors: B J
authors: BJ
authors: Wagner
authors: T J
authors: TJ
authors: Imray
authors: C F
authors: CF
authors: Adair
authors: A J
authors: AJ
authors: Davidson
mesh_terms: D000302:Adrenal Cortex / Q000473:pathology*; D000306:Adrenal Cortex Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018246:Adrenocortical Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology; D018268:Adrenocortical Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed