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Adrenocortical Carcinoma
Adam G. Johnson, MD; Paige Bennett, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Adrenocortical carcinoma (ACC): Rare, aggressive malignancy arising from adrenal cortex
              • Classic appearance
                • Irregularly shaped
                • Unilateral
                • ≥ 4 cm
                • Central necrosis
                • Calcifications
                • Local invasion
              • Common sites of metastases
                • Liver
                • Lung
                • Bone
                • Lymph nodes

          IMAGING

          • F-18 FDG PET/CT Findings

            • CT Findings

              • MR Findings

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Staging, Grading, & Classification

                      • Gross Pathologic & Surgical Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  Selected References

                                  1. Fassnacht M et al: Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 175(2):G1-G34, 2016
                                  2. Mendichovszky IA et al: Targeted molecular imaging in adrenal disease-An emerging role for metomidate PET-CT. Diagnostics (Basel). 6(4), 2016
                                  3. Cistaro A et al: Diagnostic and prognostic value of 18F-FDG PET/CT in comparison with morphological imaging in primary adrenal gland malignancies - a multicenter experience. Hell J Nucl Med. 18(2):97-102, 2015
                                  4. Libé R et al: Prognostic factors in stage III-IV adrenocortical carcinomas (ACC): an European Network for the Study of Adrenal Tumor (ENSAT) study. Ann Oncol. 26(10):2119-25, 2015
                                  5. Bednarski BK et al: Borderline resectable adrenal cortical carcinoma: a potential role for preoperative chemotherapy. World J Surg. 38(6):1318-27, 2014
                                  6. Takeuchi S et al: Impact of ¹⁸F-FDG PET/CT on the management of adrenocortical carcinoma: analysis of 106 patients. Eur J Nucl Med Mol Imaging. 41(11):2066-73, 2014
                                  7. Tessonnier L et al: (18)F-FDG uptake at initial staging of the adrenocortical cancers: a diagnostic tool but not of prognostic value. World J Surg. 37(1):107-12, 2013
                                  8. Boland GW et al: Characterization of adrenal masses by using FDG PET: a systematic review and meta-analysis of diagnostic test performance. Radiology. 259(1):117-26, 2011
                                  9. Deandreis D et al: FDG PET in the management of patients with adrenal masses and adrenocortical carcinoma. Horm Cancer. 2(6):354-62, 2011
                                  10. Zini L et al: Contemporary management of adrenocortical carcinoma. Eur Urol. 60(5):1055-65, 2011
                                  11. Lughezzani G et al: The European Network for the Study of Adrenal Tumors staging system is prognostically superior to the international union against cancer-staging system: a North American validation. Eur J Cancer. 46(4):713-9, 2010
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Definitions

                                            • Adrenocortical carcinoma (ACC): Rare, aggressive malignancy arising from adrenal cortex
                                              • Classic appearance
                                                • Irregularly shaped
                                                • Unilateral
                                                • ≥ 4 cm
                                                • Central necrosis
                                                • Calcifications
                                                • Local invasion
                                              • Common sites of metastases
                                                • Liver
                                                • Lung
                                                • Bone
                                                • Lymph nodes

                                          IMAGING

                                          • F-18 FDG PET/CT Findings

                                            • CT Findings

                                              • MR Findings

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    • Staging, Grading, & Classification

                                                      • Gross Pathologic & Surgical Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  Selected References

                                                                  1. Fassnacht M et al: Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 175(2):G1-G34, 2016
                                                                  2. Mendichovszky IA et al: Targeted molecular imaging in adrenal disease-An emerging role for metomidate PET-CT. Diagnostics (Basel). 6(4), 2016
                                                                  3. Cistaro A et al: Diagnostic and prognostic value of 18F-FDG PET/CT in comparison with morphological imaging in primary adrenal gland malignancies - a multicenter experience. Hell J Nucl Med. 18(2):97-102, 2015
                                                                  4. Libé R et al: Prognostic factors in stage III-IV adrenocortical carcinomas (ACC): an European Network for the Study of Adrenal Tumor (ENSAT) study. Ann Oncol. 26(10):2119-25, 2015
                                                                  5. Bednarski BK et al: Borderline resectable adrenal cortical carcinoma: a potential role for preoperative chemotherapy. World J Surg. 38(6):1318-27, 2014
                                                                  6. Takeuchi S et al: Impact of ¹⁸F-FDG PET/CT on the management of adrenocortical carcinoma: analysis of 106 patients. Eur J Nucl Med Mol Imaging. 41(11):2066-73, 2014
                                                                  7. Tessonnier L et al: (18)F-FDG uptake at initial staging of the adrenocortical cancers: a diagnostic tool but not of prognostic value. World J Surg. 37(1):107-12, 2013
                                                                  8. Boland GW et al: Characterization of adrenal masses by using FDG PET: a systematic review and meta-analysis of diagnostic test performance. Radiology. 259(1):117-26, 2011
                                                                  9. Deandreis D et al: FDG PET in the management of patients with adrenal masses and adrenocortical carcinoma. Horm Cancer. 2(6):354-62, 2011
                                                                  10. Zini L et al: Contemporary management of adrenocortical carcinoma. Eur Urol. 60(5):1055-65, 2011
                                                                  11. Lughezzani G et al: The European Network for the Study of Adrenal Tumors staging system is prognostically superior to the international union against cancer-staging system: a North American validation. Eur J Cancer. 46(4):713-9, 2010