EURORAD ESR

Case 10490

Adrenocortical carcinoma: imaging findings

Author(s)
Alexandra Ntorkou1, Athina C. Tsili1, Anna Gousia2, Maria I. Argyropoulou1

(1)Department of Clinical Radiology
(2)Department of Pathology

University Hospital of Ioannina,
Clinical Radiology,
Dept. Of Radiology;
Pl. Patgis 2
45332 Ioannina, Greece;
Email:a_tsili@yahoo.gr
 
Patient
female, 56 year(s)
 
 
  • Figure 1
    US examination
     

    Gray scale sonography depicts a large inhomogenous, mainly hypoechoic mass in the area of the right adrenal gland, in close proximity to the liver. The dimensions of the tumour are 7.5×8.5 cm (cursors).

     
    Area of Interest: Adrenals; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Gray scale sonography demonstrates the tumour (asterisk) displacing the right kidney. Liver invasion by the neoplasm (arrowhead) is clearly evident.

     
    Area of Interest: Adrenals; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 2
    CT examination
     

    Unenhanced transverse CT shows a heterogeneous, hypoattenuating mass (arrow) in the area of the right adrenal gland, with irregular contours, in close proximity to the right lobe of the liver.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Comparative studies; Special Focus: Neoplasia;

    Post-contrast CT image (portal phase) depicts inhomogenous enhancement by the neoplasm and direct invasion of the liver (arrow).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Comparative studies; Special Focus: Neoplasia;

    Post-contrast CT image, coronal reformation depicts strongly and heterogeneously enhancing right adrenal mass. Areas that do not enhance corresponded to areas of necrosis on pathology. The tumour invades the adjacent...

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Comparative studies; Special Focus: Neoplasia;
     
     
  • Figure 3
    Chest CT examination

    Transverse chest CT image reveals small round lung lesion (arrowhead) suggestive for the presence of metastases.

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;
     
     
  • Figure 4
    MRI examination
     

    Transverse T1-weighted image depicts a large slightly inhomogenous right suprarenal mass (arrow), mainly hypointense when compared to the adjacent normal liver parenchyma.

     
    Area of Interest: Adrenals; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Transverse T2-weighted image shows an ill-defined, heterogeneous mass (arrow) in the area of the right adrenal gland. The tumour has areas of high and very high signal intensity compared to the normal liver.

     
    Area of Interest: Adrenals; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;

    Transverse DW image (b700 s/mm2) demonstrates tumour hyperintensity (arrow), suggestive of restriction of water molecules movement, therefore confirming the diagnosis of malignancy.

     
    Area of Interest: Adrenals; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Corresponding ADC map shows tumour hypointensity (arrow). The ADC values within the mass are 0.62 mm2/s (normal left kidney parenchyma: 2.01 mm2/s).

     
    Area of Interest: Adrenals; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;
     
     
  • Figure 5
    Histologic section.
     

    Nests of neoplastic cells with diffuse pattern of growth (H/E X100).

     
    Area of Interest: Adrenals; Imaging Technique: RIS; Procedure: Comparative studies; Special Focus: Neoplasia;

    There are nuclear hyperchromasia, mitotic activity and areas of necrosis (H/E X 200).

     
    Area of Interest: Adrenals; Imaging Technique: RIS; Procedure: Comparative studies; Special Focus: Neoplasia;
     
     
Gray scale sonography depicts a large inhomogenous, mainly hypoechoic mass in the area of the right adrenal gland, in close proximity to the liver. The dimensions of the tumour are 7.5×8.5 cm (cursors).
 
Gray scale sonography demonstrates the tumour (asterisk) displacing the right kidney. Liver invasion by the neoplasm (arrowhead) is clearly evident.
 
Unenhanced transverse CT shows a heterogeneous, hypoattenuating mass (arrow) in the area of the right adrenal gland, with irregular contours, in close proximity to the right lobe of the liver.
 
Post-contrast CT image (portal phase) depicts inhomogenous enhancement by the neoplasm and direct invasion of the liver (arrow).
 
Post-contrast CT image, coronal reformation depicts strongly and heterogeneously enhancing right adrenal mass. Areas that do not enhance corresponded to areas of necrosis on pathology. The tumour invades the adjacent liver parenchyma (arrowheads).
 
Transverse chest CT image reveals small round lung lesion (arrowhead) suggestive for the presence of metastases.
 
Transverse T1-weighted image depicts a large slightly inhomogenous right suprarenal mass (arrow), mainly hypointense when compared to the adjacent normal liver parenchyma.
 
Transverse T2-weighted image shows an ill-defined, heterogeneous mass (arrow) in the area of the right adrenal gland. The tumour has areas of high and very high signal intensity compared to the normal liver.
 
Transverse DW image (b700 s/mm2) demonstrates tumour hyperintensity (arrow), suggestive of restriction of water molecules movement, therefore confirming the diagnosis of malignancy.
 
Corresponding ADC map shows tumour hypointensity (arrow). The ADC values within the mass are 0.62 mm2/s (normal left kidney parenchyma: 2.01 mm2/s).
 
Nests of neoplastic cells with diffuse pattern of growth (H/E X100).
 
There are nuclear hyperchromasia, mitotic activity and areas of necrosis (H/E X 200).
 
 
 
Home Search Sections Teaching Cases History FAQ Case Archives Contact Login Disclaimer Imprint Switch to MOBILE version
View desktop version