Malignant Adrenal Masses

In this video lecture, we discuss the diagnosis and imaging appearance of malignant adrenal masses: adrenal metastases including collision tumor, adrenocortical carcinoma and adrenal lymphoma.
Key points include:
1) Adrenal metastases are the most common malignant lesion involving the adrenal gland.
2) Lung carcinoma is the most common primary malignancy to metastasize to the adrenal glands.
3) Adrenal metastases are often bilateral and greater than 3 cm in size.
4) When malignant adrenal lesions are compared to adenomas, SUV cutoff of 3.1 has a 99% negative predictive value.
5) Adrenal-to-liver SUV ratio cutoff value of 1.4 has a specificity of 100% in differentiating adrenal adenomas and metastases.
6) Collision tumors are two histologically distinct tumors that abut or are near each other in the adrenal gland, and PET/CT is the best way to characterize these lesions without biopsy.
7) An enlarging defect within adrenal signal dropout on T1-weighted opposed-phase GRE images is suspicious for a metastatic collision tumor abutting a lipid-rich adrenal adenoma.
8) Renal cell carcinoma metastases can be slow growing and occur many years after the initial tumor presentation.
9) Adrenocortical carcinoma has a bimodal age distribution, may be hormonally functioning and has a poor prognosis.
10) Adrenocortical carcinoma usually presents as a large (greater than 6 cm) mass with internal hemorrhage, necrosis and sometimes calcification.
11) Venous invasion is common with adrenocortical carcinoma.
12) Adrenal lymphoma will be round or adreniform in shape and frequently shows restricted diffusion, a feature that can be helpful in differentiating from adrenal hyperplasia.
13) Diffuse large B-cell lymphoma is the most common type of adrenal lymphoma, and patients usually present with B-cell symptoms and/or adrenal insufficiency.
14) Adrenal lymphoma is usually bilateral and may invade the adjacent kidney(s).
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[@yasirhassan2596]

Very informative 🏆

[@Radquarters]

Glad you liked it!

[@The-Seeker-]

Fantastic!

[@Radquarters]

Many thanks Fetal Imaging!

[@kaylaplotner]

Thank you for such an informative video! I go in tomorrow to see a Endocrinologist due to my DHEA-S levels being high. What is the common outcome for having higher levels as a female?

[@Radquarters]

Glad it was helpful! Your endocrinologist could best address your DHEA-S level question.

[@mazklassa9338]

Hi. I'm considering strongly, since the lower back pain in my kidneys is utterly intolerable, of having a scan on my abdomen to see what on earth might be happening. Bearing in mind I have little to no scientific acumen or knowledge to investigate this in the most economical way, other than to simply use my gut feeling to go with having some kind of scan. Based on just wanting a 1st scan for a "let's see if we can find anything" approach, would you recommend MRI or CT or CT/PET?
Edit: thanks in advance if you'd be so kind to reply x

[@Radquarters]

I'm sorry to hear about your lower back pain, but I'm afraid that this channel is only for educational purposes and I cannot offer medical advice. I would recommend that you talk to your doctor about the next best step. I hope you feel better!