Clinical, Biochemical, and Radiological Characteristics of a Single-Center Retrospective Cohort of 705 Large Adrenal Tumors

Abstract

ObjectiveTo characterize large adrenal tumors (≥4 cm in diameter) and to identify features associated with malignancy.Patients and MethodsWe investigated the clinical, biochemical, and imaging characteristics in a large retrospective single-center cohort of patients with adrenal tumors of 4 cm or more in diameter during the period of January 1, 2000, through December 31, 2014.ResultsOf 4085 patients with adrenal tumors, 705 (17%) had adrenal masses measuring 4 cm or more in diameter; of these, 373 (53%) were women, with a median age of 59 years (range, 18-91 years) and median tumor size of 5.2 cm (range, 4.0-24.4 cm). Underlying diagnoses were adrenocortical adenomas (n=216 [31%]), pheochromocytomas (n=158 [22%]), other benign adrenal tumors (n=116 [16%]), adrenocortical carcinomas (n=88 [13%]), and other malignant tumors (n=127 [18%]). Compared with benign tumors, malignant tumors were less frequently diagnosed incidentally (45.5% vs 86.7%), were larger (7 cm [range, 4-24.4 cm] vs 5 cm [range, 4-20 cm]), and had higher unenhanced computed tomographic (CT) attenuation (34.5 Hounsfield units [HU] [range, 14.1-75.5 HU] vs 11.5 HU [range, −110 to 71.3 HU]; P<.001). On multivariate analysis, older age at diagnosis, male sex, nonincidental mode of discovery, larger tumor size, and higher unenhanced CT attenuation were all found to be statistically significant predictors of malignancy.ConclusionThe prevalence of malignancy in patients with adrenal tumors of 4 cm or more in diameter was 31%. Older age, male sex, nonincidental mode of discovery, larger tumor size, and higher unenhanced CT attenuation were associated with an increased risk for malignancy. Clinical context should guide management in patients with adrenal tumors of 4 cm or more in diameter.

Characteristics of adrenocortical carcinoma in South Korea: a registry-based nationwide survey

“…There were 111 cases of abdominal pain and/or palpable abdominal mass as symptoms at diagnosis (59.4% of known information), which is a higher rate than previous studies. Iñiguez-Ariza et al reported the mode of ACC discovery as follows: 42% incidentally found, 32% hormone excess, and 20% mass effect (29). Several patients reported no symptoms even when the mass was larger than 8 cm.…”

“…Iñiguez-Ariza et al . reported the mode of ACC discovery as follows: 42% incidentally found, 32% hormone excess, and 20% mass effect ( 29 ). Several patients reported no symptoms even when the mass was larger than 8 cm.…”

Urine steroid metabolomics for the differential diagnosis of adrenal incidentalomas in the EURINE-ACT study: a prospective test validation study

“…These tumours account for 2–12% of adrenal incidentalomas. 10 , 11 , 12 , 13 Prognosis of ACC is poor and cure is achievable only with early detection and surgery. 14 Multimodal and repeated imaging is routinely used to detect and exclude ACC, despite an insufficient evidence base to support this approach due to small studies in heterogeneous populations and with poor reference standards.…”

Primary adrenal leiomyosarcoma with inferior vena cava extension in a 70-year-old man

“…In fact, this cut-off of 4 cm to delineate potential malignancy (34%–61% specific) is challenged by Iniguez et al , in which only 31% of adrenal tumours above 4 cm were malignant. However, two notable risk factors for malignancy in this study were larger tumour size (7 cm) and non-incidental mode of discovery, suggesting that imaging still serves an integral role in the evaluation of adrenal tumours 10–12. Additionally, we utilised radiological guidance in the form of a CT-guided biopsy to ascertain a tissue diagnosis for our patient prior to surgical resection.…”