Preexisting adrenal masses in patients with adrenocortical carcinoma: clinical and radiological factors contributing to delayed diagnosis

Adrenocortical carcinoma (ACC) is a rare endocrine malignancy that is usually large (>5 cm) at time of diagnosis. Delayed diagnosis significantly worsens survival. We describe adrenal gland morphology prior to ACC diagnosis and discern potential causes of delayed diagnosis. ACC patients seen at T...

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Veröffentlicht in:Endocrine 2016-02, Vol.51 (2), p.351-359
Hauptverfasser: Ozsari, Levent, Kutahyalioglu, Merve, Elsayes, Khaled M., Vicens, Rafael Andres, Sircar, Kanishka, Jazaerly, Tarek, Waguespack, Steven G., Busaidy, Naifa L., Cabanillas, Maria E., Dadu, Ramona, Hu, Mimi I., Vassilopoulou-Sellin, Rena, Jimenez, Camilo, Lee, Jeffrey E., Habra, Mouhammed Amir
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container_end_page 359
container_issue 2
container_start_page 351
container_title Endocrine
container_volume 51
creator Ozsari, Levent
Kutahyalioglu, Merve
Elsayes, Khaled M.
Vicens, Rafael Andres
Sircar, Kanishka
Jazaerly, Tarek
Waguespack, Steven G.
Busaidy, Naifa L.
Cabanillas, Maria E.
Dadu, Ramona
Hu, Mimi I.
Vassilopoulou-Sellin, Rena
Jimenez, Camilo
Lee, Jeffrey E.
Habra, Mouhammed Amir
description Adrenocortical carcinoma (ACC) is a rare endocrine malignancy that is usually large (>5 cm) at time of diagnosis. Delayed diagnosis significantly worsens survival. We describe adrenal gland morphology prior to ACC diagnosis and discern potential causes of delayed diagnosis. ACC patients seen at The University of Texas MD Anderson Cancer Center between 1998 and 2014 who had cross-sectional body imaging ≥3 months prior to their diagnosis. We conducted a detailed review of clinical and radiological features in these patients prior to ACC diagnosis. Of 439 patients with ACC, 25 had imaging preceding ACC diagnosis (5 with normal adrenal glands and 20 with preexisting masses). On the first available images, the median mass size was 2.8 cm (range 0–9) with median precontrast density of 36 Hounsfield units (range 17–43) and became 9 cm (range 1–18) at the time of ACC diagnosis. The median interval between first available image and ACC diagnosis was 20 months (range 3–89). In the 5 patients whose initial images showed normal adrenal glands, the time between the last normal scan and ACC diagnosis ranged from 5 to 36 months. The most common reason for delayed ACC diagnosis was the presumed benign status of the preexisting mass ( n  = 13, 65 %). Radiologically suspicious adrenal masses can precede ACC diagnosis and have variable growth patterns. ACC can also develop de novo within a few months in a radiologically documented normal adrenal gland. The presumed benignancy of preexisting masses based on size is the main reason for delayed ACC diagnosis.
doi_str_mv 10.1007/s12020-015-0694-7
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In the 5 patients whose initial images showed normal adrenal glands, the time between the last normal scan and ACC diagnosis ranged from 5 to 36 months. The most common reason for delayed ACC diagnosis was the presumed benign status of the preexisting mass ( n  = 13, 65 %). Radiologically suspicious adrenal masses can precede ACC diagnosis and have variable growth patterns. ACC can also develop de novo within a few months in a radiologically documented normal adrenal gland. 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Delayed diagnosis significantly worsens survival. We describe adrenal gland morphology prior to ACC diagnosis and discern potential causes of delayed diagnosis. ACC patients seen at The University of Texas MD Anderson Cancer Center between 1998 and 2014 who had cross-sectional body imaging ≥3 months prior to their diagnosis. We conducted a detailed review of clinical and radiological features in these patients prior to ACC diagnosis. Of 439 patients with ACC, 25 had imaging preceding ACC diagnosis (5 with normal adrenal glands and 20 with preexisting masses). On the first available images, the median mass size was 2.8 cm (range 0–9) with median precontrast density of 36 Hounsfield units (range 17–43) and became 9 cm (range 1–18) at the time of ACC diagnosis. The median interval between first available image and ACC diagnosis was 20 months (range 3–89). 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subjects Adrenal Cortex Neoplasms - pathology
Adrenal Glands - pathology
Adrenalectomy
Adrenocortical Carcinoma - pathology
Adult
Aged
Aged, 80 and over
Delayed Diagnosis
Diabetes
Endocrinology
Humanities and Social Sciences
Humans
Internal Medicine
Male
Medicine
Medicine & Public Health
Middle Aged
multidisciplinary
Original Article
Science
Young Adult
title Preexisting adrenal masses in patients with adrenocortical carcinoma: clinical and radiological factors contributing to delayed diagnosis
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