Rak kory nadnerczy w przedoperacyjnych badaniach obrazowych

Bibliogr. s. 35

Background: Decisions concerning surgical treatment of patients with adrenocortical tumor without hormonal hyperactivity are based on tumor size exceeding 3-6 cm and morphological features of malignancy. The aim of the study was to analyze results of diagnostic imaging in patients with adrenocortical carcinoma (ACC). Material/Methods: Results of diagnostic imaging of 8 patients in whom postoperative pathological examination revealed ACC were analyzed. There were 3 women and 5 men in the analyzed group, with an age range of 32 to 75 years. Imaging was based on US and CT examination supported by MRI in 2 patients. The obtained results were compared with a group of 10 patients with adrenocortical adenoma (ACA). Results are presented as median values and 95% CI. Results: CT results of patients with ACC showed local spread into surrounding fat tissue in 87.5%, adjacent organ invasion in 75%, local lymph node enlargement in 75%, irregular tumor margins in 88%, and heterogeneous structure of all tumors. In patients with ACA, tumor heterogeneity was observed in 40% and local lymph node enlargement in 10%. ACC tumors were significantly larger than ACA ones [77 (66-97) vs. 31 (24-48) mm, respectively, p=0.0002] and more dense [60 (34-85) vs. 16 (10-26) HU, respectively, p=0.0007]. In arterial phase, enhancement of ACC tumors tended to be stronger compared with ACA [81 (29-162) vs. 55 (33-76), p=0.09]. On the basis of CT results, 1 patient was classified as stage II according to Mac Farlane, 6 as stage III, and 1 as stage IV. Intraoperative examination down-staged 2 patients from stage III to stage II. Conclusions: Computed tomography is a method that allows distinguishing adrenocortical adenoma from carcinoma as well as to determine the stage of adrenocortical carcinoma.