Large adrenal mass heralding the diagnosis of occult extra-adrenal malignancy in two patients

Abstract

We report two cases highlighting the role of fluorine-18-fluorodeoxyglucose positron emission tomography/computerised tomography (18F FDG PET/CT) in the diagnostic and preoperative workup of indeterminate adrenal masses. Case 1: a 60-year-old man was diagnosed with a large left-sided adrenal mass with indeterminate radiological characteristics on CT. Biochemical investigations ruled out tumour hypersecretion. 18F FDG PET/CT was performed to exclude metastases and identified a pulmonary nodule in the left upper lobe. Histology of the resected adrenal tumour demonstrated a secondary metastasis from an adenocarcinoma of the lung. Case 2: an 88-year-old male was found to have a heterogeneous and vascular left-sided suprarenal mass and a smaller right-sided adrenal nodule. Both adrenal nodules had indeterminate radiological characteristics. Biochemical investigations were negative. PET/CT demonstrated high avidity in the bilateral adrenal nodules but no extra-adrenal FDG avid disease. Histology demonstrated a metastatic carcinoma of pulmonary origin.

Right Adrenocortical Carcinoma Coexisting With Left Adrenal Sarcomatoid Carcinoma on FDG PET/CT

“…FDG PET/CT can play important roles in the evaluation of adrenal lesions 1,2,5,6 . FDG-avid bilateral adrenal masses are often indicative of the same type of diseases, including pheochromocytoma, 7 lymphoma, 8 metastases, 9 myelolipoma, 10 and infective diseases 11,12 . Our case indicates that possibility of the coexistence of 2 different pathologies should not be ignored when bilateral hypermetabolic adrenal lesions were noted on FDG PET/CT.…”

Brain and Adrenal Metastasis From Unknown Primary Tumor: A Case Report

“…There is insufficient evidence suggesting that adrenalectomy for AM-CUP improves prognosis; however, a case report of AM-CUP presented an uneventful outcome [ 7 ]. Additionally, Sastry et al reported that adrenalectomy for adrenal metastasis from lung cancer increased the long-term survival rate compared to chemotherapy or radiotherapy alone [ 20 ].…”

“…The frequency of unknown primary cancers presenting as adrenal masses is reportedly 0.2% [ 5 ]. Only a few case reports have been published regarding AM-CUP [ 6 , 7 ]. These patients presented with metastatic lesions only in the adrenal gland.…”