title: From the radiologic pathology archives: Adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation.
abstract: Advanced imaging often reveals adrenal tumors and tumor-like conditions in both symptomatic and asymptomatic patients. When adrenal disease is clinically suspected, cross-sectional imaging can be helpful in evaluating the etiology of the patient's symptoms. When adrenal disease is incidentally identified, what the clinician and patient really want to know is whether the findings are benign or malignant, as this ultimately will affect their next step in management. Using radiologic-pathologic correlation, we broadly classify common, uncommon, and rare tumors and tumor-like conditions that can occur in the adrenal as benign or malignant. This classification follows predominant trends in observed biologic behavior while acknowledging those tumors that may behave in the minority in an unpredictable manner. We review the clinical background and presentation of functional adrenal tumors including Conn syndrome, Cushing syndrome, and catecholamine-secreting tumors, as well as their relationship with adrenal anatomy. We discuss a variety of benign tumors, including adrenal cortical adenoma (including oncocytoma) and pheochromocytoma, as well as uncommonly and rarely encountered tumors such as myelolipoma, hemangioma, lymphangioma, schwannoma, ganglioneuroma, and adenomatoid tumor. A variety of tumefactive but nonneoplastic lesions are addressed, including adrenal cortical hyperplasia, adrenal hemorrhage, adrenal cysts, and infections. Malignant tumors discussed include adrenal cortical carcinoma, the rare malignant pheochromocytoma, lymphoma, metastases, and sarcomas. For each tumor and tumor-like lesion, the clinical presentation, epidemiology, key imaging findings, diagnostic differential considerations, and management options are briefly addressed. Finally, an approach to the workup of suspected or incidentally discovered tumors is presented based on a selected literature survey and our clinical experience. Radiologists play an important role in identification and diagnosis of adrenal tumors and tumor-like conditions in both symptomatic and asymptomatic patients.
authors.affiliation: From the Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (G.E.L., C.A.T., J.M., W.D.C.); American Institute for Radiologic Pathology, Silver Spring, Md (G.E.L., E.D.S., W.D.C.); Department of Radiology, Naval Medical Center Portsmouth, Portsmouth, Va (E.D.S.); Department of Radiology, David Grant USAF Medical Center, Travis AFB, Calif (C.A.T.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (J.M.); School of Medicine, Georgetown University, Washington, DC (K.W.S.); Department of Radiology, Suburban Hospital, Bethesda, Md (W.D.C.); and Department of Endocrine Pathology, The Joint Pathology Center, Silver Spring, Md (E.E.L.).
authors.forename: Grant E
authors.initials: GE
authors.lastname: Lattin
authors.forename: Eric D
authors.initials: ED
authors.lastname: Sturgill
authors.forename: Charles A
authors.initials: CA
authors.lastname: Tujo
authors.forename: Jamie
authors.initials: J
authors.lastname: Marko
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Sanchez-Maldonado
authors.forename: William D
authors.initials: WD
authors.lastname: Craig
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Lack
mesh_terms: D000305:Adrenal Cortex Hormones / Q000378:metabolism; D000307:Adrenal Gland Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary; D000328:Adult; D002395:Catecholamines / Q000378:metabolism; D003480:Cushing Syndrome / Q000209:etiology; D003560:Cysts / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005262:Feminization / Q000209:etiology; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D006929:Hyperaldosteronism / Q000209:etiology; D006965:Hyperplasia; D033162:Incidental Findings; D008297:Male; D014057:Tomography, X-Ray Computed; D014770:Virilism / Q000209:etiology
chemical_list: D000305:Adrenal Cortex Hormones; D002395:Catecholamines