Adrenocortical carcinoma differential diagnosis: Difference between revisions

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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Adrenal adenoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Adrenal adenoma
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*  
* Symptoms related to  excess [[glucocorticoid]]
* Symptoms related to  excess [[mineralocorticoid]]
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* Round and homogeneous density, smooth contour and sharp margination
* Round and homogeneous density, smooth contour and sharp margination
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Adrenocortica'''l carcinoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Adrenocortica'''l carcinoma
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* Mass effect symptoms; symptoms related to  excess glucocorticoid, mineralocorticoid, androgen, or estrogen secretion
* Mass effect symptoms
* Symptoms related to  excess [[glucocorticoid]]
* Symptoms related to  excess [[mineralocorticoid]]
* Symptoms related to  excess [[androgen]] or [[estrogen]] secretion
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* Irregular shape
* Irregular shape
* Inhomogeneous density because of central areas of low attenuation due to tumor necrosis
* Inhomogeneous density because of central areas of low attenuation due to tumor necrosis
* Tumor calcification
* [[Tumor]] [[calcification]]
* Diameter usually >4 cm
* Diameter usually >4 cm
* Unilateral location
* Unilateral location
* High unenhanced CT attenuation values (>20 HU)
* High unenhanced [[Computed tomography|CT]] attenuation values (>20 HU)
* Inhomogeneous enhancement on CT with intravenous contrast
* Inhomogeneous enhancement on CT with intravenous [[Contrast medium|contrast]]
* Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
* Delay in [[contrast medium]] washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
* Hypointensity compared with liver on T1 weighted MRI and high to intermediate signal intensity on T2 weighted MRI
* Hypointensity compared with [[liver]] on T1 weighted [[Magnetic resonance imaging|MRI]] and high to intermediate signal intensity on T2 weighted [[Magnetic resonance imaging|MRI]]
* High standardized uptake value (SUV) on FDG-PET-CT study
* High standardized uptake value (SUV) on FDG-[[PET scan|PET-CT]] study
* Evidence of local invasion or metastases
* Evidence of local invasion or [[Metastasis|metastases]]
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* Serum DHEAS
* Serum [[DHEAS]]
* Measures of clinically indicated steroid
*  
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* [[Headache]]
* [[Headache]]
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* Imaging may show adenoma if presents
* Imaging may show [[mass]] if presents
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* 24-hour urine [[cortisol]]
* 24-hour urine [[cortisol]]
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Pheochromocytoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Pheochromocytoma
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* [[Palpitations]] especially in epinephrine producing tumors.<sup>[[Pheochromocytoma history and symptoms#cite note-pmid8325290-3|[3]]]</sup>
* [[Palpitations]] especially in epinephrine producing tumors.
* [[Anxiety]] often resembling that of a [[panic attack]]
* [[Anxiety]] often resembling that of a [[panic attack]]
* [[Sweating]]
* [[Sweating]]
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* It may be [[asymptomatic]] and discovered incidentally after [[Screening (medicine)|screening]] for [[MEN, type 2|MEN]] patients.
* It may be [[asymptomatic]] and discovered incidentally after [[Screening (medicine)|screening]] for [[MEN, type 2|MEN]] patients.
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* Increased attenuation on nonenhanced CT (>20 HU)
* Increased attenuation on nonenhanced [[Computed tomography|CT]] (>20 HU)
* Increased mass vascularity (image 2)
* Increased [[mass]] vascularity
* Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
* Delay in [[contrast medium]] washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
* High signal intensity on T2 weighted MRI (image 3)
* High signal intensity on T2 weighted [[Magnetic resonance imaging|MRI]]
* Cystic and hemorrhagic changes
* Cystic and hemorrhagic changes
* Variable size and may be bilateral
* Variable size and may be bilateral
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Adrenal metastasis
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Adrenal metastasis
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** Symptoms and signs of primary malignancy especially lung cancer.
** Symptoms and signs of primary [[malignancy]] especially [[lung cancer]]
** General constitutional symptoms:
** General constitutional symptoms:
** Fever  
** [[Fever]]
** Fatigue
** [[Fatigue]]
** Weight loss
** [[Weight loss]]
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* Irregular shape and inhomogeneous nature
* Irregular shape and inhomogeneous nature
* Tendency to be bilateral
* Tendency to be bilateral
* High unenhanced CT attenuation values (>20 HU) and enhancement with intravenous contrast on CT
* High unenhanced [[Computed tomography|CT]] attenuation values (>20 HU) and enhancement with [[Contrast medium|intravenous contrast]] on [[Computed tomography|CT]]
* Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
* Delay in [[contrast medium]] washout (10 minutes after administration of contrast, an absolute [[contrast medium]] washout of less than 50 percent)
* Isointensity or slightly less intense than the liver on T1 weighted MRI and high to intermediate signal intensity on T2 weighted MRI (representing an increased water content)
* Isointensity or slightly less intense than the liver on T1 weighted [[Magnetic resonance imaging|MRI]] and high to intermediate signal intensity on T2 weighted [[Magnetic resonance imaging|MRI]] (representing an increased water content)
* Elevated standardized uptake value on FDG-PET scan
* Elevated standardized uptake value on FDG-[[PET scan]]
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Revision as of 15:35, 24 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]Ahmad Al Maradni, M.D. [3]

Overview

Adrenocortical carcinoma must be differentiated from other diseases such as adrenocortical adenoma, renal cell carcinoma, adrenal medullary tumors, and hepatocellular carcinoma.

Differentiating Adrenal Carcinoma from other Diseases

Adrenocortical carcinoma should be differentiated from:

Differential Diagnosis Clinical picture Imagings Laboratory tests
Adrenal adenoma
  • Round and homogeneous density, smooth contour and sharp margination
  • Diameter less than 4 cm, unilateral location
  • Low unenhanced CT attenuation values (<10 HU)
  • Rapid contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of more than 50 percent)
  • Isointensity with liver on both T1 and T2 weighted MRI sequences
  • Chemical shift: evidence of lipid on MRI
Adrenocortical carcinoma
  • Irregular shape
  • Inhomogeneous density because of central areas of low attenuation due to tumor necrosis
  • Tumor calcification
  • Diameter usually >4 cm
  • Unilateral location
  • High unenhanced CT attenuation values (>20 HU)
  • Inhomogeneous enhancement on CT with intravenous contrast
  • Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
  • Hypointensity compared with liver on T1 weighted MRI and high to intermediate signal intensity on T2 weighted MRI
  • High standardized uptake value (SUV) on FDG-PET-CT study
  • Evidence of local invasion or metastases
Cushing's syndrome
  • Imaging may show mass if presents
Pheochromocytoma
  • Increased attenuation on nonenhanced CT (>20 HU)
  • Increased mass vascularity
  • Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
  • High signal intensity on T2 weighted MRI
  • Cystic and hemorrhagic changes
  • Variable size and may be bilateral
Adrenal metastasis
  • Irregular shape and inhomogeneous nature
  • Tendency to be bilateral
  • High unenhanced CT attenuation values (>20 HU) and enhancement with intravenous contrast on CT
  • Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
  • Isointensity or slightly less intense than the liver on T1 weighted MRI and high to intermediate signal intensity on T2 weighted MRI (representing an increased water content)
  • Elevated standardized uptake value on FDG-PET scan

References