An adrenocortical carcinoma can be suspected as the cause of an adrenal mass based on its imaging features.



(1) typically >= 4.0 cm in diameter but may be smaller

(2) stable to rapidly enlarging (> 2.0 cm per year)

(3) usually solitary and unilateral


Shape: irregular with unclear margins


Imaging features of an adrenal carcinoma:

(1) heterogeneous texture with areas showing mixed densities

(2) attenuation (density) on unenhanced CT is usually > 25 Hounsfield units (almost all have a density > 10 HU)

(3) vascular

(4) washout of contrast material is < 50% at 10 minutes

(5) T2-weighted MRI images are hyperintense in relation to the liver

(6) necrosis and hemorrhage are common

(7) calcifications are common


It may be difficult to distinguish an adrenocortical carcinoma from a pheochromocytoma on imaging studies. The features favoring adenocarcinoma:

(1) hormonal activity

(2) irregular shape with unclear margins

(3) less cystic

(4) more calcifications


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