Two Cases of Adrenal Malignancy With Macroscopic Fat

Area of Science:

• Radiology
• Oncology
• Pathology

Background:

• Macroscopic fat on computed tomography (CT) imaging is typically associated with benign adrenal myelolipomas.
• Adrenal lesions with macroscopic fat are often presumed benign, requiring no further investigation.

Observation:

• Two cases are presented where adrenal lesions with macroscopic fat were histologically confirmed as malignant.
• The first case involved adrenocortical carcinoma, and the second case involved undifferentiated sarcoma.
• Both malignant cases exhibited other clinical and radiological signs suggestive of malignancy.

Findings:

• Malignant adrenal tumors can, in rare instances, contain macroscopic fat.
• The presence of fat does not exclude the possibility of malignancy in adrenal lesions.

Implications:

• These findings highlight the importance of clinical vigilance when evaluating adrenal lesions, even those with apparent fat.
• Radiologists and clinicians should consider the possibility of malignancy despite the presence of macroscopic fat.
• Further investigation may be warranted for adrenal lesions with suspicious clinical or radiological features, irrespective of fat content.