medical decision support medical decision support
Sign In

Findings of Gaujoux and Mihai Associated with an Adrenocortical Adenocarcinoma in a Patient with an Adrenal Mass

Description

Gaujoux and Mihai listed findings associated with an adrenocortical adenocarcinoma in a patient with an adrenal mass. These can help triage the patient for surgery. The study was conducted by the European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumors (ENSAT).


Patient selection: adrenal mass

 

Parameters:

(1) tumor diameter in cm

(2) spontaneous density in HU

(3) signal loss on chemical-shift imaging on MRI

(4) 18-FDG-PET uptake

(5) central enhancement

(6) wash-out after intravenous injection of contrast material

(7) hormonal secretion

(8) local invasion

(9) metastastic disease (lymph nodes, distant)

 

Parameters:

Finding Suggesting Malignancy

tumor diameter in cm

> 6 cm (risk increased if > 4 cm)

spontaneous density in HU

> 10 HU

signal loss on chemical-shift imaging on MRI

below 20%

18-FDG-PET uptake

high

central enhancement

low (due to areas of necrosis and hemorrhage)

wash-out after intravenous injection of contrast material

slow

hormonal secretion

androgen, estrogen, steroid precursor, multiple

local invasion

present

metastases

present

 

Biopsy is usually avoided because adverse effects in patients with pheochromocytoma or adrenocortical carcinoma. It may be performed if malignant lymphoma or metastatic cancer is expected.

 

If the tumor is <= 6 cm and there is no evidence of local invasion or metastases, then laparoscopic surgery may be attempted. Otherwise all cases should have open surgery at a referral center.


To read more or access our algorithms and calculators, please log in or register.

Specialty