Adrenal Mass in a Patient with High-Risk RCC - Renal and Urology News

Adrenal Mass in a Patient with High-Risk RCC

Slideshow

  • Slide 1

A 63-year-old man with history of a pT2N0M0 Stage II Grade 3 clear cell renal cell carcinoma who had undergone a laparoscopic left radical nephrectomy 18 months ago is found to have a new right adrenal mass.

The mass measures 3 cm in diameter and demonstrates an attenuation of 25 HU on non-contrast computed tomography (CT) scan.

A CT 15-minute adrenal washout study is performed and demonstrates 65% absolute washout characteristics.

Classically, adrenal masses that "washout," or lose more than 40%-60% of contrast enhancement 15 minutes after the contrast bolus, are managed as adenomas, since the specificity of an adrenal washout study is extremely high.1-9Recent data, however, reveal that RCC (and...

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Classically, adrenal masses that “washout,” or lose more than 40%-60% of contrast enhancement 15 minutes after the contrast bolus, are managed as adenomas, since the specificity of an adrenal washout study is extremely high.1-9

Recent data, however, reveal that RCC (and hepatocellular carcinoma) metastases can exhibit washout characteristics identical to lipid-poor adenomas.10 These new findings have important clinical implications.

Answer: Given washout characteristics, the lesion is not a metastasis

This case was prepared by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia.

References

  1. Grumbach MM, Biller BMK, Braunstein GD, et al. Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med 2003;138:424-429.
  2. Szolar DH, Korobki M, Reittner P, et al. Adrenocortical carcinomas and adrenal pheochromocytomas: Mass and enhancement loss evaluation at delayed contrast-enhanced CT. Radiology 2005;234:479-485.
  3. Korobkin M, Brodeur FJ, Francis IR, et al. CT time-attenuation washout curves of adrenal adenomas and nonadenomas. Am J Roentgenol 1998;170:747-752.
  4. Pena CS, Boland GW, Hahn PF, et al. Characterization of indeterminate (lipid-poor) adrenal masses: Use of washout characteristics at contrast-enhanced CT. Radiology 2000;217:798-802.
  5. Israel GM, Korobkin M, Wang C, et al. Comparison of unenhanced CT and chemical shift MRI in evaluating lipid-rich adrenal adenomas. Am J Roentgenol 2004;183:215-219.
  6. Haider MA, Ghai S, Jhaveri K, et al. Chemical shift MR imaging of hyperattenuating (>10 HU) adrenal masses: does it still have a role? Radiology 2004;231:711-716.
  7. Boland GW, Blake MA, Hahn PF, et al. Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization. Radiology 2008;249:756-775.
  8. Hussain HK, Korobkin M. MR imaging of the adrenal glands. Magn Reson Imaging Clin N Am 2004;12:515-544.
  9. Kutikov A, Crispen PL, Uzzo RG. Pathophysiology, evaluation, and medical management of adrenal disorders. In: Campbell-Walsh Urology, 10th ed. Edited by Wein AJ, Kavoussi LR, Partin AW, et al. Philadelphia: Elsevier, p. in press, 2011
  10. Choi YA, Kim CK, Park BK, Kim B. Evaluation of adrenal metastases from renal cell carcinoma and hepatocellular carcinoma: use of delayed contrast-enhanced CT. Radiology 2013;266:514-520.
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