From the Archives of the AFIP1
Adrenocortical Neoplasms in Children: Radiologic-Pathologic Correlation
Geoffrey A. Agrons, MD,
Gael J. Lonergan, Lt Col, USAF, MC,
Glenn E. Dickey, Lt Col, USAF, MC and
Juan E. Perez-Monte, MD
1 From the Departments of Radiology, Pennsylvania Hospital, 800 Spruce St, Philadelphia, PA, 19107 (G.A.A., J.E.P-M.); Radiologic Pathology (G.J.L.) and Pediatric Pathology (G.E.D.), Armed Forces Institute of Pathology, Washington, DC; Radiology, Children's Hospital of Philadelphia (G.A.A.), Penn; and Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (G.J.L.). Received February 4, 1999; revision requested March 3 and received April 14; accepted April 15. Address reprint requests to G.A.A.
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Figure 1a. Mixed endocrine syndrome in a 7-month-old boy with an adrenocortical neoplasm. (a) Photograph of the patient at 4 months shows normal facies. (b) Photograph of the same patient at 7 months demonstrates moon facies, acne, and bitemporal excess hair growth. Penile enlargement and premature pubic hair growth were also present.
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Figure 1b. Mixed endocrine syndrome in a 7-month-old boy with an adrenocortical neoplasm. (a) Photograph of the patient at 4 months shows normal facies. (b) Photograph of the same patient at 7 months demonstrates moon facies, acne, and bitemporal excess hair growth. Penile enlargement and premature pubic hair growth were also present.
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Figures 2, 3. (2) Virilization in a 3-year-old girl with an adrenocortical tumor. Clinical photograph of the external genitalia shows clitoromegaly and early pubic hair growth. (3) Adrenocortical neoplasm in a 16-year-old girl with amenorrhea and hirsutism. (a) Clinical photograph shows facial and chest hair and absence of breast development. (b) Axial contrast material-enhanced computed tomographic (CT) scan of the abdomen demonstrates a heterogeneous left flank mass containing a large focus of low attenuation (arrowhead), consistent with necrosis. Retroperitoneal adenopathy (arrow) partly encases the abdominal aorta.
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Figures 2, 3. (2) Virilization in a 3-year-old girl with an adrenocortical tumor. Clinical photograph of the external genitalia shows clitoromegaly and early pubic hair growth. (3) Adrenocortical neoplasm in a 16-year-old girl with amenorrhea and hirsutism. (a) Clinical photograph shows facial and chest hair and absence of breast development. (b) Axial contrast material-enhanced computed tomographic (CT) scan of the abdomen demonstrates a heterogeneous left flank mass containing a large focus of low attenuation (arrowhead), consistent with necrosis. Retroperitoneal adenopathy (arrow) partly encases the abdominal aorta.
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Figures 2, 3. (2) Virilization in a 3-year-old girl with an adrenocortical tumor. Clinical photograph of the external genitalia shows clitoromegaly and early pubic hair growth. (3) Adrenocortical neoplasm in a 16-year-old girl with amenorrhea and hirsutism. (a) Clinical photograph shows facial and chest hair and absence of breast development. (b) Axial contrast material-enhanced computed tomographic (CT) scan of the abdomen demonstrates a heterogeneous left flank mass containing a large focus of low attenuation (arrowhead), consistent with necrosis. Retroperitoneal adenopathy (arrow) partly encases the abdominal aorta.
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Figure 4a. Adrenocortical neoplasm in a 3-year-old boy with a 2-year history of pubic hair growth, penile enlargement, deepening voice, and acne. (a) Frontal photograph of the patient demonstrates precocious development of secondary sexual characteristics, evidenced by penile enlargement, pubic hair, and increased muscle mass. (b) Photograph of the patient's back shows extensive acne. (c) Frontal radiograph of the left hand demonstrates accelerated skeletal maturation (estimated at 12 years). (d) Transverse abdominal sonogram shows a heterogeneous retrohepatic mass (arrow). (e) Contrast-enhanced CT scan reveals the slightly ill-defined heterogeneous right suprarenal mass.
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Figure 4b. Adrenocortical neoplasm in a 3-year-old boy with a 2-year history of pubic hair growth, penile enlargement, deepening voice, and acne. (a) Frontal photograph of the patient demonstrates precocious development of secondary sexual characteristics, evidenced by penile enlargement, pubic hair, and increased muscle mass. (b) Photograph of the patient's back shows extensive acne. (c) Frontal radiograph of the left hand demonstrates accelerated skeletal maturation (estimated at 12 years). (d) Transverse abdominal sonogram shows a heterogeneous retrohepatic mass (arrow). (e) Contrast-enhanced CT scan reveals the slightly ill-defined heterogeneous right suprarenal mass.
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Figure 4c. Adrenocortical neoplasm in a 3-year-old boy with a 2-year history of pubic hair growth, penile enlargement, deepening voice, and acne. (a) Frontal photograph of the patient demonstrates precocious development of secondary sexual characteristics, evidenced by penile enlargement, pubic hair, and increased muscle mass. (b) Photograph of the patient's back shows extensive acne. (c) Frontal radiograph of the left hand demonstrates accelerated skeletal maturation (estimated at 12 years). (d) Transverse abdominal sonogram shows a heterogeneous retrohepatic mass (arrow). (e) Contrast-enhanced CT scan reveals the slightly ill-defined heterogeneous right suprarenal mass.
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Figure 4d. Adrenocortical neoplasm in a 3-year-old boy with a 2-year history of pubic hair growth, penile enlargement, deepening voice, and acne. (a) Frontal photograph of the patient demonstrates precocious development of secondary sexual characteristics, evidenced by penile enlargement, pubic hair, and increased muscle mass. (b) Photograph of the patient's back shows extensive acne. (c) Frontal radiograph of the left hand demonstrates accelerated skeletal maturation (estimated at 12 years). (d) Transverse abdominal sonogram shows a heterogeneous retrohepatic mass (arrow). (e) Contrast-enhanced CT scan reveals the slightly ill-defined heterogeneous right suprarenal mass.
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Figure 4e. Adrenocortical neoplasm in a 3-year-old boy with a 2-year history of pubic hair growth, penile enlargement, deepening voice, and acne. (a) Frontal photograph of the patient demonstrates precocious development of secondary sexual characteristics, evidenced by penile enlargement, pubic hair, and increased muscle mass. (b) Photograph of the patient's back shows extensive acne. (c) Frontal radiograph of the left hand demonstrates accelerated skeletal maturation (estimated at 12 years). (d) Transverse abdominal sonogram shows a heterogeneous retrohepatic mass (arrow). (e) Contrast-enhanced CT scan reveals the slightly ill-defined heterogeneous right suprarenal mass.
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Figure 5a. Pathologic features of adrenocortical neoplasm. (a) Photomicrograph (original magnification, x300; hematoxylin-eosin [H-E] stain) shows large, pale vacuolated cells (arrow) and smaller cells (arrowhead) with eosinophilic cytoplasm, representing benign features. (b) Photomicrograph (original magnification, x300; H-E stain) of a malignant adrenocortical neoplasm shows nuclear atypia, pleomorphism, multinucleated forms (straight arrow), and atypical mitoses (curved arrow). (c) Photograph of sectioned surgical specimen of an adrenocortical carcinoma demonstrates a nodular appearance, extensive hemorrhage, and necrosis. Scale is in inches.
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Figure 5b. Pathologic features of adrenocortical neoplasm. (a) Photomicrograph (original magnification, x300; hematoxylin-eosin [H-E] stain) shows large, pale vacuolated cells (arrow) and smaller cells (arrowhead) with eosinophilic cytoplasm, representing benign features. (b) Photomicrograph (original magnification, x300; H-E stain) of a malignant adrenocortical neoplasm shows nuclear atypia, pleomorphism, multinucleated forms (straight arrow), and atypical mitoses (curved arrow). (c) Photograph of sectioned surgical specimen of an adrenocortical carcinoma demonstrates a nodular appearance, extensive hemorrhage, and necrosis. Scale is in inches.
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Figure 5c. Pathologic features of adrenocortical neoplasm. (a) Photomicrograph (original magnification, x300; hematoxylin-eosin [H-E] stain) shows large, pale vacuolated cells (arrow) and smaller cells (arrowhead) with eosinophilic cytoplasm, representing benign features. (b) Photomicrograph (original magnification, x300; H-E stain) of a malignant adrenocortical neoplasm shows nuclear atypia, pleomorphism, multinucleated forms (straight arrow), and atypical mitoses (curved arrow). (c) Photograph of sectioned surgical specimen of an adrenocortical carcinoma demonstrates a nodular appearance, extensive hemorrhage, and necrosis. Scale is in inches.
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Figure 6. Adrenocortical tumor in a 17-year-old girl with a 4-month history of lassitude. Spot radiograph from a selective right inferior adrenal arteriogram demonstrates neovascularity and puddling of contrast material within a large right suprarenal mass.
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Figure 7a. Adrenocortical neoplasm in a 2-year-old girl with an abdominal mass and recent development of pubic hair. (a) Longitudinal US image of the abdomen reveals a homogeneous, solid right suprarenal mass. (b) Contrast-enhanced CT scan demonstrates the circumscribed right suprarenal mass (arrow), which enhances slightly more than the adjacent liver. (c) Photograph of the bisected surgical specimen shows a smooth, homogeneous, reddish-brown tumor.
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Figure 7b. Adrenocortical neoplasm in a 2-year-old girl with an abdominal mass and recent development of pubic hair. (a) Longitudinal US image of the abdomen reveals a homogeneous, solid right suprarenal mass. (b) Contrast-enhanced CT scan demonstrates the circumscribed right suprarenal mass (arrow), which enhances slightly more than the adjacent liver. (c) Photograph of the bisected surgical specimen shows a smooth, homogeneous, reddish-brown tumor.
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Figure 7c. Adrenocortical neoplasm in a 2-year-old girl with an abdominal mass and recent development of pubic hair. (a) Longitudinal US image of the abdomen reveals a homogeneous, solid right suprarenal mass. (b) Contrast-enhanced CT scan demonstrates the circumscribed right suprarenal mass (arrow), which enhances slightly more than the adjacent liver. (c) Photograph of the bisected surgical specimen shows a smooth, homogeneous, reddish-brown tumor.
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Figure 8a. Adrenocortical tumor in an 18-month-old boy with precocious puberty. (a) Longitudinal sonogram of the left flank demonstrates a large, heterogeneous mass (straight arrows, M) containing scattered cystic spaces. The left kidney (curved arrow) is compressed and displaced inferiorly. (b) Contrast-enhanced CT scan shows the heterogeneous left flank mass with a faintly enhancing, capsule-like rim (arrow), associated with a contralateral retroperitoneal nodal mass (arrowhead). (c) Photograph of the sectioned surgical specimen demonstrates extensive cystic change due to hemorrhage and necrosis. At surgery, one of seven nodes contained tumor.
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Figure 8b. Adrenocortical tumor in an 18-month-old boy with precocious puberty. (a) Longitudinal sonogram of the left flank demonstrates a large, heterogeneous mass (straight arrows, M) containing scattered cystic spaces. The left kidney (curved arrow) is compressed and displaced inferiorly. (b) Contrast-enhanced CT scan shows the heterogeneous left flank mass with a faintly enhancing, capsule-like rim (arrow), associated with a contralateral retroperitoneal nodal mass (arrowhead). (c) Photograph of the sectioned surgical specimen demonstrates extensive cystic change due to hemorrhage and necrosis. At surgery, one of seven nodes contained tumor.
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Figure 8c. Adrenocortical tumor in an 18-month-old boy with precocious puberty. (a) Longitudinal sonogram of the left flank demonstrates a large, heterogeneous mass (straight arrows, M) containing scattered cystic spaces. The left kidney (curved arrow) is compressed and displaced inferiorly. (b) Contrast-enhanced CT scan shows the heterogeneous left flank mass with a faintly enhancing, capsule-like rim (arrow), associated with a contralateral retroperitoneal nodal mass (arrowhead). (c) Photograph of the sectioned surgical specimen demonstrates extensive cystic change due to hemorrhage and necrosis. At surgery, one of seven nodes contained tumor.
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Figure 9a. Adrenocortical tumor in an 8-month-old girl with pubic hair. (a) Longitudinal sonogram demonstrates a heterogeneous, solid, left flank mass containing a shadowing echogenic focus (arrow), consistent with calcification. (b) Axial unenhanced CT scan of the abdomen shows the large left flank mass with faint calcifications (arrow). (c) Contrast-enhanced CT scan shows heterogeneous enhancement of the mass, low-attenuation regions (curved arrow) consistent with necrosis, and faint enhancement of a capsule-like rim (straight arrows).
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Figure 9b. Adrenocortical tumor in an 8-month-old girl with pubic hair. (a) Longitudinal sonogram demonstrates a heterogeneous, solid, left flank mass containing a shadowing echogenic focus (arrow), consistent with calcification. (b) Axial unenhanced CT scan of the abdomen shows the large left flank mass with faint calcifications (arrow). (c) Contrast-enhanced CT scan shows heterogeneous enhancement of the mass, low-attenuation regions (curved arrow) consistent with necrosis, and faint enhancement of a capsule-like rim (straight arrows).
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Figure 9c. Adrenocortical tumor in an 8-month-old girl with pubic hair. (a) Longitudinal sonogram demonstrates a heterogeneous, solid, left flank mass containing a shadowing echogenic focus (arrow), consistent with calcification. (b) Axial unenhanced CT scan of the abdomen shows the large left flank mass with faint calcifications (arrow). (c) Contrast-enhanced CT scan shows heterogeneous enhancement of the mass, low-attenuation regions (curved arrow) consistent with necrosis, and faint enhancement of a capsule-like rim (straight arrows).
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Figure 10a. Adrenocortical neoplasm in a 13-year-old girl with hirsutism and hypertension. (a) Contrast-enhanced CT scan of the abdomen reveals a bulky, lobulated, heterogeneous left flank mass. Curvilinear foci of high attenuation (arrow), consistent with calcification, delimit tumor lobules. (b) Coronal T1-weighted (repetition time msec/echo time msec = 670/15) MR image shows a left flank mass of heterogeneous and predominantly low signal intensity. A renal origin is suggested by the beak of normal renal parenchyma (arrowhead) about the inferior aspect of the tumor. The kidney is seen below the mass (arrows). (c) Coronal proton density-weighted (2,500/22) MR image demonstrates heterogeneous increased signal intensity within the lesion. (d) Photograph of the surgical specimen sectioned sagittally shows the inferior margin (arrows) of the lobulated and necrotic mass apparently invading the upper pole of the left kidney. However, no invasion of the renal capsule was seen at microscopy.
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Figure 10b. Adrenocortical neoplasm in a 13-year-old girl with hirsutism and hypertension. (a) Contrast-enhanced CT scan of the abdomen reveals a bulky, lobulated, heterogeneous left flank mass. Curvilinear foci of high attenuation (arrow), consistent with calcification, delimit tumor lobules. (b) Coronal T1-weighted (repetition time msec/echo time msec = 670/15) MR image shows a left flank mass of heterogeneous and predominantly low signal intensity. A renal origin is suggested by the beak of normal renal parenchyma (arrowhead) about the inferior aspect of the tumor. The kidney is seen below the mass (arrows). (c) Coronal proton density-weighted (2,500/22) MR image demonstrates heterogeneous increased signal intensity within the lesion. (d) Photograph of the surgical specimen sectioned sagittally shows the inferior margin (arrows) of the lobulated and necrotic mass apparently invading the upper pole of the left kidney. However, no invasion of the renal capsule was seen at microscopy.
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Figure 10c. Adrenocortical neoplasm in a 13-year-old girl with hirsutism and hypertension. (a) Contrast-enhanced CT scan of the abdomen reveals a bulky, lobulated, heterogeneous left flank mass. Curvilinear foci of high attenuation (arrow), consistent with calcification, delimit tumor lobules. (b) Coronal T1-weighted (repetition time msec/echo time msec = 670/15) MR image shows a left flank mass of heterogeneous and predominantly low signal intensity. A renal origin is suggested by the beak of normal renal parenchyma (arrowhead) about the inferior aspect of the tumor. The kidney is seen below the mass (arrows). (c) Coronal proton density-weighted (2,500/22) MR image demonstrates heterogeneous increased signal intensity within the lesion. (d) Photograph of the surgical specimen sectioned sagittally shows the inferior margin (arrows) of the lobulated and necrotic mass apparently invading the upper pole of the left kidney. However, no invasion of the renal capsule was seen at microscopy.
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Figure 10d. Adrenocortical neoplasm in a 13-year-old girl with hirsutism and hypertension. (a) Contrast-enhanced CT scan of the abdomen reveals a bulky, lobulated, heterogeneous left flank mass. Curvilinear foci of high attenuation (arrow), consistent with calcification, delimit tumor lobules. (b) Coronal T1-weighted (repetition time msec/echo time msec = 670/15) MR image shows a left flank mass of heterogeneous and predominantly low signal intensity. A renal origin is suggested by the beak of normal renal parenchyma (arrowhead) about the inferior aspect of the tumor. The kidney is seen below the mass (arrows). (c) Coronal proton density-weighted (2,500/22) MR image demonstrates heterogeneous increased signal intensity within the lesion. (d) Photograph of the surgical specimen sectioned sagittally shows the inferior margin (arrows) of the lobulated and necrotic mass apparently invading the upper pole of the left kidney. However, no invasion of the renal capsule was seen at microscopy.
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Figure 11a. Adrenocortical tumor in an 18-month-old boy with pubic hair. (a) Longitudinal right renal sonogram depicts a round, circumscribed, hypoechoic suprarenal mass (arrow). (b) Coronal T1-weighted (530/15) MR image shows the homogeneous mass that is nearly isointense relative to the renal cortex. (c) Axial T2-weighted (3,400/90) MR image reveals a moderate increase in signal intensity within the lesion, which appears distinct from the normal right adrenal gland (arrow). A well-encapsulated mass arising from a posterior limb of the right adrenal gland was found at surgery.
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Figure 11b. Adrenocortical tumor in an 18-month-old boy with pubic hair. (a) Longitudinal right renal sonogram depicts a round, circumscribed, hypoechoic suprarenal mass (arrow). (b) Coronal T1-weighted (530/15) MR image shows the homogeneous mass that is nearly isointense relative to the renal cortex. (c) Axial T2-weighted (3,400/90) MR image reveals a moderate increase in signal intensity within the lesion, which appears distinct from the normal right adrenal gland (arrow). A well-encapsulated mass arising from a posterior limb of the right adrenal gland was found at surgery.
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Figure 11c. Adrenocortical tumor in an 18-month-old boy with pubic hair. (a) Longitudinal right renal sonogram depicts a round, circumscribed, hypoechoic suprarenal mass (arrow). (b) Coronal T1-weighted (530/15) MR image shows the homogeneous mass that is nearly isointense relative to the renal cortex. (c) Axial T2-weighted (3,400/90) MR image reveals a moderate increase in signal intensity within the lesion, which appears distinct from the normal right adrenal gland (arrow). A well-encapsulated mass arising from a posterior limb of the right adrenal gland was found at surgery.
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Figure 12a. Obstruction of the inferior vena cava by tumor thrombus in a 15-year-old girl with a palpable abdominal mass and bilateral lower extremity swelling. (a) Contrast-enhanced chest CT scan (mediastinal window) shows the intrahepatic segment of the inferior vena cava (black arrow) distended by heterogeneously enhancing soft tissue. Dilated azygous (white arrow) and hemiazygous (arrowhead) veins represent collateral pathways of systemic venous return. A right pleural effusion is present. (b) CT scan obtained cephalad to a demonstrates a lobulated, right atrial filling defect (arrow). (c) Coronal T2-weighted (4,000/102) MR image reveals the primary tumor (arrowhead) in continuity with inferior vena cava thrombus (arrow) that extends into the right atrium.
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Figure 12b. Obstruction of the inferior vena cava by tumor thrombus in a 15-year-old girl with a palpable abdominal mass and bilateral lower extremity swelling. (a) Contrast-enhanced chest CT scan (mediastinal window) shows the intrahepatic segment of the inferior vena cava (black arrow) distended by heterogeneously enhancing soft tissue. Dilated azygous (white arrow) and hemiazygous (arrowhead) veins represent collateral pathways of systemic venous return. A right pleural effusion is present. (b) CT scan obtained cephalad to a demonstrates a lobulated, right atrial filling defect (arrow). (c) Coronal T2-weighted (4,000/102) MR image reveals the primary tumor (arrowhead) in continuity with inferior vena cava thrombus (arrow) that extends into the right atrium.
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Figure 12c. Obstruction of the inferior vena cava by tumor thrombus in a 15-year-old girl with a palpable abdominal mass and bilateral lower extremity swelling. (a) Contrast-enhanced chest CT scan (mediastinal window) shows the intrahepatic segment of the inferior vena cava (black arrow) distended by heterogeneously enhancing soft tissue. Dilated azygous (white arrow) and hemiazygous (arrowhead) veins represent collateral pathways of systemic venous return. A right pleural effusion is present. (b) CT scan obtained cephalad to a demonstrates a lobulated, right atrial filling defect (arrow). (c) Coronal T2-weighted (4,000/102) MR image reveals the primary tumor (arrowhead) in continuity with inferior vena cava thrombus (arrow) that extends into the right atrium.
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Figure 13a. Adrenocortical tumor in a 7-week-old girl with acne and hypertension. (a) Axial contrast-enhanced CT scan of the abdomen shows a circumscribed, heterogeneous left suprarenal mass. (b, c) Longitudinal sonograms of the kidneys show the hypoechoic left suprarenal mass associated with hyperechoic renal pyramids (arrow in c), representing medullary nephrocalcinosis. (d) Axial T1-weighted (600/15) MR image of the abdomen obtained inferior to the level of the mass reveals increased retroperitoneal fat (arrows) due to Cushing syndrome.
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Figure 13b. Adrenocortical tumor in a 7-week-old girl with acne and hypertension. (a) Axial contrast-enhanced CT scan of the abdomen shows a circumscribed, heterogeneous left suprarenal mass. (b, c) Longitudinal sonograms of the kidneys show the hypoechoic left suprarenal mass associated with hyperechoic renal pyramids (arrow in c), representing medullary nephrocalcinosis. (d) Axial T1-weighted (600/15) MR image of the abdomen obtained inferior to the level of the mass reveals increased retroperitoneal fat (arrows) due to Cushing syndrome.
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Figure 13c. Adrenocortical tumor in a 7-week-old girl with acne and hypertension. (a) Axial contrast-enhanced CT scan of the abdomen shows a circumscribed, heterogeneous left suprarenal mass. (b, c) Longitudinal sonograms of the kidneys show the hypoechoic left suprarenal mass associated with hyperechoic renal pyramids (arrow in c), representing medullary nephrocalcinosis. (d) Axial T1-weighted (600/15) MR image of the abdomen obtained inferior to the level of the mass reveals increased retroperitoneal fat (arrows) due to Cushing syndrome.
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Figure 13d. Adrenocortical tumor in a 7-week-old girl with acne and hypertension. (a) Axial contrast-enhanced CT scan of the abdomen shows a circumscribed, heterogeneous left suprarenal mass. (b, c) Longitudinal sonograms of the kidneys show the hypoechoic left suprarenal mass associated with hyperechoic renal pyramids (arrow in c), representing medullary nephrocalcinosis. (d) Axial T1-weighted (600/15) MR image of the abdomen obtained inferior to the level of the mass reveals increased retroperitoneal fat (arrows) due to Cushing syndrome.
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Figure 14a. Metastatic adrenocortical carcinoma in a 17-year-old girl with fatigue, weight gain, and hypertension. (a) Unenhanced axial CT scan of the abdomen shows a large, lobulated, right flank mass containing punctate calcifications (arrow). (b) On a CT scan obtained after intravenous contrast material administration, the mass enhances heterogeneously and displays low-attenuation regions representing hemorrhage and necrosis. The inferior vena cava (arrow) is compressed, displaced, and possibly invaded. (c) Axial contrast-enhanced CT scan through the upper abdomen shows a low-attenuation metastasis (arrow) in the liver dome.
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Figure 14b. Metastatic adrenocortical carcinoma in a 17-year-old girl with fatigue, weight gain, and hypertension. (a) Unenhanced axial CT scan of the abdomen shows a large, lobulated, right flank mass containing punctate calcifications (arrow). (b) On a CT scan obtained after intravenous contrast material administration, the mass enhances heterogeneously and displays low-attenuation regions representing hemorrhage and necrosis. The inferior vena cava (arrow) is compressed, displaced, and possibly invaded. (c) Axial contrast-enhanced CT scan through the upper abdomen shows a low-attenuation metastasis (arrow) in the liver dome.
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Figure 14c. Metastatic adrenocortical carcinoma in a 17-year-old girl with fatigue, weight gain, and hypertension. (a) Unenhanced axial CT scan of the abdomen shows a large, lobulated, right flank mass containing punctate calcifications (arrow). (b) On a CT scan obtained after intravenous contrast material administration, the mass enhances heterogeneously and displays low-attenuation regions representing hemorrhage and necrosis. The inferior vena cava (arrow) is compressed, displaced, and possibly invaded. (c) Axial contrast-enhanced CT scan through the upper abdomen shows a low-attenuation metastasis (arrow) in the liver dome.
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Figure 15. Pulmonary metastases from adrenocortical carcinoma in an 8-year-old girl with a 1-year history of precocious puberty. Frontal radiograph of the chest demonstrates multiple spherical peripheral nodules. The right adrenal mass (not shown) measured 4 cm in diameter.
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Copyright © 1999 by the Radiological Society of North America.
