title: Radiographic Characteristics of Adrenal Masses Preceding the Diagnosis of Adrenocortical Cancer.
abstract: Incidentally discovered adrenal masses are common and the clinical evaluation and surveillance aims to diagnose hormone excess and malignancy. Adrenocortical cancer (ACC) is a very rare malignancy. This study aims to define the imaging characteristics of adrenal tumors preceding the diagnosis of ACC. Patients with prior (>5 months) adrenal tumors (<6 cm) subsequently diagnosed with ACC were identified in a large registry at a tertiary referral center. Retrospective chart and image review for patient characteristics and initial, interval, and diagnostic imaging characteristics (size, homogeneity, borders, density, growth rate, etc.) was conducted. Twenty patients with a diagnosis of ACC and a prior adrenal tumor were identified among 422 patients with ACC. Of these, 17 patients were initially imaged with CT and 3 with MR. Only 2 of the 20 patients had initial imaging characteristics suggestive of a benign lesion. Of initial tumors, 25% were <2 cm in size. Surveillance led to the diagnosis of ACC within 24 months in 50% of patients. The growth pattern was variable with some lesions showing long-term stability (up to 8 years) in size. In conclusion, antecedent lesions in patients with a diagnosis of ACC are often indeterminate by imaging criteria and can be small. Surveillance over 2 years detected only 50% of ACCs. Current practice and guidelines are insufficient in diagnosing ACCs. Given the rarity of ACC, the increased risk and health care costs of additional evaluation may not be warranted.
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: T M
authors.initials: TM
authors.lastname: Nogueira
authors.forename: R
authors.initials: R
authors.lastname: Lirov
authors.forename: E M
authors.initials: EM
authors.lastname: Caoili
authors.forename: A M
authors.initials: AM
authors.lastname: Lerario
authors.forename: B S
authors.initials: BS
authors.lastname: Miller
authors.forename: M C B V
authors.initials: MC
authors.lastname: Fragoso
authors.forename: N R
authors.initials: NR
authors.lastname: Dunnick
authors.forename: G D
authors.initials: GD
authors.lastname: Hammer
authors.forename: T
authors.initials: T
authors.lastname: Else
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000175:diagnosis* / Q000473:pathology; D000311:Adrenal Glands / Q000473:pathology*; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed