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- Alexander L. Shifrin, MD
Cancer of the adrenal gland called adrenocortical carcinoma (ACC). It is on of the most malignant endocrine tumors. 60% of ACC secrete hormones, most commonly - corticosteroids. Some patients have signs of virilization. When Cushing's syndrome is rapidly progressing, ACC is suspected (Figure 1). It is very difficult to treat ACC when disease is progressed. It is metastasize to the liver (Figure 2), lung (Figure 3) and bones (Figure 4). PET CT could be helpfull as well in detecting adrenal cancers after completion of prior tests (Figure 5, 6). The only hope for cure of ACC is early diagnosis and early surgery (Figure 7 - this patient had surgery early enough to prevent metastasis that were presented on Figure 2 - 4).
Up to 14% of adrenal incidentalomas are ACC. So when adrenal incidentaloma starts rapid growing or diagnosed with size 3.5 - 4 cm, then ACC is suspected and early surgery is recommended. Besides surgery chemotherapy is initiated but results are not satisfactory.
Figure 1. CT scan of the large adrenocortical carcinoma on the left side (right side on the picture) that metastisized by the time the diagnosis was made.
Figure 2. CT scan. Liver metastaseis from adrenocortical carcinoma
Figure 3. CT scan. Lung metastases from adrenocortical carcinoma
Figure 4. MRI. Bones metastases from adrenocortical carcinoma
Figure 5. PET CT highliting right adrenocortical carcinoma (frontal view)
Figure 6. PET CT highliting right adrenocortical carcinoma (transverse view)
Figure 7. Adrenocortical carcinoma that was removed form the diffrent patint (then above) who did not developed metastasis at the time of diagnosis.