Adreno-cortical carcinoma with vascular invasion.

Diagnosis

Adreno-cortical carcinoma with vascular invasion.

Diagnosis

Adreno-cortical carcinoma with vascular invasion.

History

Eight-year-girl with virilization and hypertension. Biochemical markers demonstrated increased plasmatic estradiol, testosterone, DHEAS and normal adrenalin , noadrenaline and dopamine.

Findings

Right adrenal hypermetabolic lesion with extension in the inferior vena cava and right atrium

Discussion

Adrenocortical carcinoma is a very rare tumor in the pediatric population. Clinical presentation of virilization due to hormonal secretion is found in 90% of patients.
Only a few pediatric patients imaged with FDG PET/CT have been reported.
This case had a significant invasion of the inferior vena cava and right atrium which was well depicted by FDG PET/CT.
Treatment consisted in the combination of surgery and chemotherapy with significant improvement in both anatomical modalities and biomarkers.FDG PET/CT has been proposed to detect recurrence but no large studies have confirmed or infirmed its value. Further, as with other neoplasms, FDG PET/CT has a limited value for the detection of lung metastasis.

Key points

Differential diagnosis:
NeuroblastomaPheochromocytoma.

References

The use of FDG-PET and CT for the staging of adrenocortical carcinoma in children. R Kreissig et al. Pediatr Radiol 2000;30:306
F-18 FDG PET/CT Illustrating Tumor Invasion in the IVC From Adrenocortical Carcinoma. MF Cheng et al. Clin Nucl Med 2007;32:891-892
Preoperative FDG PET/CT in Adrenocortical Cancer Depicts Massive Venous Tumor Invasion. C Lapa et al. Clin Nucl Med 2014;39:570-572
Early Detection of Recurrent Pediatric Adrenal Cortical Carcinoma Using FDG-PET. I Binkovitz et al. Clin Nucl Med 2008;33:186-188F18-FDG PET/CT in the post-operative monitoring of patients with adrenocortical carcinoma. A Ardito et al. Eur J Endocrinol 2015;173:749-756.