Radiology Lectures | Radquarters

Malignant Adrenal Masses

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In this video lecture, we discuss the diagnosis and imaging appearance of malignant adrenal masses: adrenal metastases including collision tumor, adrenocortical carcinoma and adrenal lymphoma.

Key points include:

  • Adrenal metastases are the most common malignant lesion involving the adrenal gland.
  • Lung carcinoma is the most common primary malignancy to metastasize to the adrenal glands.
  • Adrenal metastases are often bilateral and greater than 3 cm in size.
  • When malignant adrenal lesions are compared to adenomas, SUV cutoff of 3.1 has a 99% negative predictive value.
  • Adrenal-to-liver SUV ratio cutoff value of 1.4 has a specificity of 100% in differentiating adrenal adenomas and metastases.
  • Collision tumors are two histologically distinct tumors that abut or are near each other in the adrenal gland, and PET/CT is the best way to characterize these lesions without biopsy.
  • An enlarging defect within adrenal signal dropout on T1-weighted opposed-phase GRE images is suspicious for a metastatic collision tumor abutting a lipid-rich adrenal adenoma.
  • Renal cell carcinoma metastases can be slow growing and occur many years after the initial tumor presentation.
  • Adrenocortical carcinoma has a bimodal age distribution, may be hormonally functioning and has a poor prognosis.
  • Adrenocortical carcinoma usually presents as a large (greater than 6 cm) mass with internal hemorrhage, necrosis and sometimes calcification.
  • Venous invasion is common with adrenocortical carcinoma.
  • Adrenal lymphoma will be round or adreniform in shape and frequently shows restricted diffusion, a feature that can be helpful in differentiating from adrenal hyperplasia.
  • Diffuse large B-cell lymphoma is the most common type of adrenal lymphoma, and patients usually present with B-cell symptoms and/or adrenal insufficiency.
  • Adrenal lymphoma is usually bilateral and may invade the adjacent kidney(s).

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    Radiology Lectures | RadquartersBy Daniel J. Kowal, MD
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