Adrenal Imaging Features Predict Malignancy Better than Tumor Size

Abstract

In resected adrenal tumors, the presence of nonbenign ImF is more sensitive for malignancy than mass size (100 vs. 55 %) with equivalent specificity. Regardless of mass size, adrenalectomy should be strongly considered when non-benign ImF are present.

Differences Between Bilateral Adrenal Incidentalomas and Unilateral Lesions

“…Adrenal imaging characteristics (including low-density on unenhanced computed tomography, the loss of signal on out-of-phase magnetic resonance images, and the rapid washout of contrast on computed tomography with delayed imaging) have been shown to be highly associated with benign, lipid-rich adenomas. 3,4 The interpretation of these imaging features should be a routine component of the evaluation of adrenal lesions and, in Pasternak et al, 1 allowed for the lateralization of a pheochromocytoma to the left side while avoiding the use of costly and often unnecessary additional imaging, such as metaiodobenzylguanidine scintigraphy.…”

“…The prevalence of these lesions has been reported to be as high as 1% to 5% of abdominal cross-sectional imaging studies performed for reasons unrelated to the adrenal gland. [1][2][3][4] Once an incidentaloma is discovered, its functional status and malignant potential should be evaluated. Multiple organizations have published guidelines outlining the evaluation of adrenal incidentalomas.…”

Integrated imaging of adrenal oncocytoma: a case of diagnostic challenge

“…This kind of tumor is extremely rare in adrenals and it is usually discovered as incidental finding because is nonfunctional; however, in about 20% of cases features suggestive for malignancy and/or adrenal hypersecretion have been reported (3). Tumor size criterion often allows to differentiate a benign from a malignant adrenal mass, but in oncocytic neoplasm neither size lesion nor imaging findings are useful for this purpose; indeed, usually oncocytomas present as large adrenal masses and surgical excision is often required (4,5). Therefore, a careful diagnostic evaluation is recommended for lesion characterization as well as for the assessment of potential malignancy.…”

Cystic adrenal lesions: focus on pediatric population (a review)

“…The adrenal medulla is the origin of tumors such as pheocromocytoma, ganglioneuroma, ganglioneuroblastoma [ 8 , 9 , 10 ]. The glands may be a secondary site of a prior cancer spreading, regardless unilateral or bilateral pattern [ 11 , 12 , 13 ]. The most frequent neoplasia with adrenal involvement is breast or lung cancer, and lymphomas [ 14 , 15 , 16 ].…”