Adrenal cortical carcinoma

Discussion:

The imaging features of this mass are not particularly suspicious for malignancy, although the size (>5 cm) and heterogeneity are worrisome features along with the endocrine abnormality that prompted imaging. Absolute washout is >60% which is compatible with an adenoma, however, the anterior component has a relative washout of <40%, which is indeterminate. MRI shows no fat signal drop-out, which is compatible with a lipid-poor adenoma, however, the restricted diffusion is concerning. The patient proceeded to resection, which demonstrates an adrenal cortical carcinoma. 

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