Primary adrenocortical carcinoma: CT evaluation with clinical correlation

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Abstract
Clinical histories and CT findings were reviewed in 38 patients with primary adrenocortical carcinomas. The primary tumors exhibited central areas of low attenuation representing tumor necrosis (n = 26), irregular contrast enhancement (n = 16), detectable calcification (n = 9), and a thin, capsulelike rim surrounding the tumor (n = 7). Tumors metastasized to liver (n = 9), lung (n = 5), and lymph nodes (n = 5). In eight of nine cases of liver metastasis the primary tumor arose in the left adrenal gland. Evidence of endocrinopathy was present in each of nine patients with lesions 6 cm or less in diameter, but in only two of seven adults with lesions exceeding 15 cm in diameter. We conclude that, contrary to established concepts, adrenocortical carcinoma may present as a smooth, homogeneous, functioning mass 6 cm or less in diameter on CT.