Adrenal Collision Tumor Diagnosed by F-18 Fluorodeoxyglucose PET/CT

Anderson, Shane B.; Webb, Matthew D.; Banks, Kevin

doi:10.1097/rlu.0b013e3181db4df1

Cited by 14 publications

(8 citation statements)

References 8 publications

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“…Only one such adrenal ‘collision tumour’ has been reported30 and the primary malignancy was an adenocarcinoma of the lung, not a HCC, as was the case in our patient. In the aforementioned single case, the adrenal gland adenoma had been identified several years before the adrenal gland metastasis had occurred.…”

Section: Discussionsupporting

confidence: 59%

Possible ACTH-independent, cortisol-secreting and DHEA-secreting metastatic hepatocellular carcinoma causing Cushing’s syndrome

et al. 2015

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Cortisol production by hepatocellular carcinoma (HCC) has not been previously reported and dehydroepiandrosterone (DHEA) secretion by HCC is rare. We report a case of a 53-year-old woman admitted with dyspnoea and headache. Serum cortisol by immunoassay (IA) was 42.3 μg/dL, urine free cortisol (UFC) by liquid chromatography mass spectrometry (LC/MS/MS) was 106.1 μg/24 h, serum DHEA by LC/MS/MS was 4886 ng/mL, serum DHEA-S by LC/MS/MS was 4477 ng/mL and plasma adrenocorticotrophic hormone (ACTH) by IA was 10 pg/mL. CT showed likely HCC metastatic to the left adrenal gland, brain and lungs. Liver and adrenal gland biopsies confirmed HCC. ACTH tumour staining was negative. High serum and UFC levels and high serum DHEA and DHEA-S with low-normal plasma ACTH and negative tumour ACTH staining suggested ACTH-independent ectopic Cushing's syndrome (CS); cortisol and DHEA being likely secreted by the HCC. To the best of our knowledge, this is the first reported case of HCC associated with CS.

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Section: Discussionsupporting

confidence: 59%

Possible ACTH-independent, cortisol-secreting and DHEA-secreting metastatic hepatocellular carcinoma causing Cushing’s syndrome

et al. 2015

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“…Another case of coexisting adrenal adenoma in the superior limb and metastatic sarcoma was proven on the biopsy guided by FDG PET/CT [191]. Another case reported a collision tumor with metastatic disease developing in a adrenal nodule previously characterized as an adenoma [192]. Tuberculosis, histoplasmosis, blastomycosis, and other granulomatous diseases affecting the adrenals usually have bilateral involvement but often asymmetrical.…”

Section: Adrenal Collision Tumorsmentioning

confidence: 96%

Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature

et al. 2014

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PET/CT with (18)F-fluorodeoxyglucose (FDG) or using different radiocompounds has proven accuracy for detection of adrenal metastases in patients undergoing cancer staging. It can assist the diagnostic work-up in oncology patients by identifying distant metastases to the adrenal(s) and defining oligometastatic disease that may benefit from targeted intervention. In patients with incidentally discovered adrenal nodules, so-called adrenal "incidentaloma" FDG PET/CT is emerging as a useful test to distinguish benign from malignant etiology. Current published evidence suggests a role for FDG PET/CT in assessing the malignant potential of an adrenal lesion that has been 'indeterminately' categorized with unenhanced CT, adrenal protocol contrast-enhanced CT, or chemical-shift MRI. FDG PET/CT could be used to stratify patients with higher risk of malignancy for surgical intervention, while recommending surveillance for adrenal masses with low malignant potential. There are caveats for interpretation of the metabolic activity of an adrenal nodule on PET/CT that may lead to false-positive and false-negative interpretation. Adrenal lesions represent a wide spectrum of etiologies, and the typical appearances on PET/CT are still being described, therefore our goal was to summarize the current diagnostic strategies for evaluation of adrenal lesions and present metabolic and anatomic appearances of common and uncommon adrenal lesions. In spite of the emerging role of PET/CT to differentiate benign from malignant adrenal mass, especially in difficult cases, it should be emphasized that PET/CT is not needed for most patients and that many diagnostic problems can be resolved by CT and/or MR imaging.

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“…Various mechanisms have been postulated, including a single carcinogenic stimulus altering a particular region of the adrenal gland, allowing two separate tumors to occur in close proximity; and the presence of one tumor altering the local environment, providing a fertile ground for the development of the other tumor [1,7]. …”

Section: Discussionmentioning

confidence: 99%

An exceedingly rare adrenal collision tumor: adrenal adenoma–metastatic breast cancer–myelolipoma

Chen

Kumar

2017

Journal of Community Hospital Internal Medicine Perspectives

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Adrenal collision tumors (ACTs), in which distinct tumors coexist without histological intermingling in the same adrenal gland, are rare and their actual prevalence is unknown. ACTs commonly consist of adrenal cortical adenoma, myelolipoma, or metastatic malignant tumor. We report a 58-year-old woman with a past history of breast cancer, who presented with a 1 month history of fevers, chills, and abdominal fullness. The physical examination and the laboratory data including endocrine studies were unremarkable. Computed tomography of the abdomen showed a right adrenal gland mass, and a laparoscopic right adrenalectomy was performed. Histological and immunohistochemical examinations revealed three distinct tumors: an adrenal cortical adenoma, a myelolipoma, and metastatic breast tumors. Breast cancer metastases are rare in the adrenal gland and exist as ACTs only in exceptionally rare cases. To our knowledge, this is the first reported case of coexisting metastatic breast tumors, adrenal adenoma, and myelolipoma in the same adrenal gland.

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Adrenal Collision Tumor Diagnosed by F-18 Fluorodeoxyglucose PET/CT

Cited by 14 publications

References 8 publications

Possible ACTH-independent, cortisol-secreting and DHEA-secreting metastatic hepatocellular carcinoma causing Cushing’s syndrome

Possible ACTH-independent, cortisol-secreting and DHEA-secreting metastatic hepatocellular carcinoma causing Cushing’s syndrome

Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature

An exceedingly rare adrenal collision tumor: adrenal adenoma–metastatic breast cancer–myelolipoma

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