Adrenal cancer

Abstract

Adrenal cortical cancer (ACC) is a rare tumor with an incidence of 1-2 per million population. Although most are identified incidentally on cross-sectional imaging, timely identification and early surgical treatment is critical for optimized treatment outcomes. Sixty percent of ACC autonomously produced adrenal cortical hormones, primarily cortisol or androgens and often present with clinical syndromes such as Cushing's syndrome or virilization. Cross-sectional imaging provides the best assessment of malignant potential. Imaging characteristics of benign neoplasms include low-density lesions (Hounsfield units < 10 on noncontrast CT, size < 4 cm, homogeneity, and rapid washout of contrast. Lipid rich adenomas show signal suppression on chemical shift MRI and very low SUV uptake on PET imaging. Since most adrenal masses are found incidentally, metabolic screening for hormone production should be performed in all cases, including patients without clinical evidence of hormone excess. Surgical resection is indicated for adrenal lesions with suspicion of malignancy and/or those exhibiting autonomous hormone production. While minimally invasive techniques may be appropriate for smaller tumors, oncologic principles should be followed. © 2013 by Nova Science Publishers, Inc. All rights reserved.