Pure Androgen-Secreting Radiologically Suspicious Adrenal Mass: Benign or Malignant?

Area of Science:

• Endocrinology
• Oncology
• Pathology

Background:

• Pure androgen-secreting adrenocortical tumors (PASATs) are rare adrenal neoplasms.
• Clinical presentation involves virilizing features, with malignancy occurring in approximately 50% of cases.
• Diagnosis and malignancy prediction rely on imaging characteristics like size, heterogeneity, and contrast washout on CT/MRI.

Observation:

• A 68-year-old postmenopausal female presented with symptoms of hyperandrogenism.
• Imaging revealed a 7-cm adrenal tumor, raising suspicion for malignancy based on CT findings.
• Surgical excision was performed for this functional adrenal tumor.

Findings:

• Post-surgical pathological examination determined the 7-cm PASAT to be benign.
• Despite concerning imaging features, the tumor did not exhibit malignant characteristics histologically.

Implications:

• This case underscores the importance of integrating clinical presentation, imaging, and surgical pathology for accurate PASAT diagnosis.
• It suggests that not all large PASATs with suspicious imaging features are necessarily malignant.
• Further research into PASAT pathogenesis and improved diagnostic criteria may enhance clinical management.