Preoperative Imaging and Suspicion of Malignancy

In addition to distant metastases and tumor size, imaging studies can provide information suggestive of malignancy. Imaging findings suggestive of malignancy include the following: CT

Stippled calcifications

A poorly delineated, rugged, somewhat square-shaped tumor, with the periodic appearance of prominent buds, very different from the round adenoma (Fig. 69-3) Areas of necrosis Aortocaval adenopathies

Evidence of local invasion; note that CT is known to overestimate the extent of liver and caval invasion

Heterogeneously increased early T2-weighted signal Weak and late enhancement after injection of gadolinium

FIGURE 69-3. Computed tomography scan showing a budding tumor in a patient with Cushing's syndrome and an adrenocortical carcinoma.

Finding of an intravascular signal identical to the tumor signal is of paramount importance and diagnostic of malignancy

131I-6P-iodomethylnorcholesterol (NP-59) scintigraphy Lack of or very weak uptake in the presence of a normal contralateral uptake22 However, 18 cases of adrenocortical carcinomas exhibiting clear uptake of NP-59 have been described.23 Virtually all of them were highly differentiated carcinomas with overt clinical hypersecretion. Bone scintigraphy—Tc 99m

Should be performed routinely in all patients with a suspicion of adrenocortical carcinoma When disseminated metastases are seen a palliative treatment rather than surgical resection is indicated As mentioned, needle biopsy should not be used because of its lack of sensitivity and risk of a capsular tear with tumor spillage, except in some patients for diagnosis of probable metastatic tumors to the adrenal.

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook

Post a comment