Molecular Imaging in the Management of Adrenocortical Cancer

Abstract

Adrenocortical cancer (ACC) is an uncommon primary neoplasm of the adrenal cortex with dismal prognosis. It often presents with symptoms and signs of adrenal cortical hormone hypersecretion and abdominal mass effect or is incidentally detected as an adrenal mass on imaging performed for other indications. Endocrine evaluation, comprehensive staging, and meticulous resection are crucial to ensure the best possible outcome. Despite extensive initial surgical resection, local and distant metastases are not uncommon with disappointing 5-year survival, although progress is being made at high-volume centers. Accurate restaging of recurrent disease is important to guide further management. Mitotane, external beam radiation and chemotherapy, and newer anticancer systemic treatments are used as adjunctives for inoperable disease and distant metastases. Contrast-enhanced CT and MRI are first-line imaging modalities for evaluation of ACC to characterize adrenal masses and to determine tumor resectability. Emerging literature supports F-FDG PET/CT use to determine the malignant potential of adrenal masses. In patients with a diagnosis of ACC, FDG PET/CT is sensitive for detecting metastatic disease, and its tumor accumulation has been correlated to pathology, Weiss scores, and prognosis. Metomidate, labeled with C for PET or with I for SPECT/CT, allows characterization of an adrenal mass as being of adrenocortical origin with high specificity. Taking advantage of its adrenocortical avidity, metomidate has been labeled with I for radionuclide therapy in a subset of ACC. In this review, we describe how nuclear medicine imaging, and specifically PET, can assist surgical management of ACC.

Oncocytic Variant of Adrenocortical Carcinoma: Case Report of a Rare Malignancy

“…Malignant adrenal masses secrete a higher ratio of DHEA than benign adenomas. Other tests include aldosterone-to-renin ratio, testosterone, estrone, 17β-estradiol, 17-OHprogesterone, androstenedione, and 24-hour urinary 17-corticosteroids measurements [1]. This patient had an elevated DHEA with no clinical evidence of hormonal imbalance.…”

“…Adrenocortical carcinoma (ACC) is a rare primary adrenal neoplasm with an incidence of 1-2 cases per million per year [1]. Oncocytic variant is a rarer subtype that represent approximately 10% of adrenocortical tumors [2].…”

Identification of mRNA-miRNA-lncRNA Competing Endogenous RNA Network in Adrenocortical Carcinoma Using Bioinformatics Analysis 

“…Adrenocortical carcinoma (ACC) is a rare, strong invasiveness and poor prognosis malignant tumor that occurs in the adrenal cortex (1,2). According to a report based on the Surveillance, Epidemiology, and End Results (SEER) database, the annual incidence of ACC is approximately 0.72 per million cases, causing to 0.2% of all cancer deaths in the United States (3).…”

Recurrence-Free Survival Following Aggressive Multimodal Treatment of an Isolated Recurrence of Adrenocortical Carcinoma

“…Adrenocortical carcinoma (ACC) is a rare cancer of the adrenal cortex that carries a poor prognosis, with an incidence of 1 to 2 cases per million per year and a 5-year survival of 25-40% [1]. Surgical resection represents the only established curative option for ACC [2] and the preferred treatment for both primary tumors and isolated metastases [3].…”