Primary adrenocortical carcinoma: CT evaluation with clinical correlation

Clinical histories and CT findings were reviewed in 38 patients with primary adrenocortical carcinomas. The primary tumors exhibited central areas of low attenuation representing tumor necrosis (n = 26), irregular contrast enhancement (n = 16), detectable calcification (n = 9), and a thin, capsulelike rim surrounding the tumor (n = 7). Tumors metastasized to liver (n = 9), lung (n = 5), and lymph nodes (n = 5). In eight of nine cases of liver metastasis the primary tumor arose in the left adrenal gland. Evidence of endocrinopathy was present in each of nine patients with lesions 6 cm or less in diameter, but in only two of seven adults with lesions exceeding 15 cm in diameter. We conclude that, contrary to established concepts, adrenocortical carcinoma may present as a smooth, homogeneous, functioning mass 6 cm or less in diameter on CT.