Prominent 18F-FDG Uptake in the Adrenal Gland after Contralateral Adrenalectomy in a Known Case of Adrenocortical Oncocytic Carcinoma

Document Type : Case report

Authors

Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan

Abstract

Adrenocortical carcinoma (ACC) is a rare type of cancer that is associated with a high rate of recurrence and poor prognosis. The main diagnostic approaches to adrenocortical cancer include CT scan, MRI and the promising role of 18F-FDG PET/CT. The main therapeutic approaches include radical surgery of local disease and recurrences, as well as adjuvant mitotane therapy.
The evaluation of adrenocortical carcinoma (ACC) could be difficult by using 18F-FDG PET/CT in view of the significant association between the 18F-FDG uptake and ACC. At the same time, not all adrenal glands with 18F-FDG uptake are considered to be malignant, so awareness of these various findings is substantial for ACC management, especially with limited data regarding the role of 18F-FDG PET/CT in ACC post-operative settings.
This report discusses the case of a 47-year-old man with a history of left adrenocortical carcinoma who underwent adrenalectomy and received adjuvant mitotane therapy. 9 months after the surgery, a follow-up 18F-FDG PET/CT scan showed that the 18F-FDG uptake was prominent in the right adrenal gland without corresponding abnormal CT scan findings.

Keywords

Main Subjects

References

  1. Mpanaka I, Lyra VD, Kaltsas G, Chatziioannou SN. High (18) F-FDG uptake by the remaining adrenal gland four months after surgery and initiation of mitotane treatment in two patients with adrenocortical carcinoma. Hellenic journal of nuclear medicine. 2011; 14(2):168-72.
  2. Deandreis D, Leboulleux S, Caramella C, Schlumberger M, Baudin E. FDG PET in the management of patients with adrenal masses and adrenocortical carcinoma. Hormones and Cancer. 2011; 2(6):354-62.
  3. Else T, Kim AC, Sabolch A, Raymond VM, Kandathil A, Caoili EM, et all. Adrenocortical Endocrine reviews. 2014; 35(2): 282-326.
  4. Becherer A, Vierhapper H, Pötzi C, Karanikas G, Kurtaran A, Schmaljohann J, et all. FDG-PET in adrenocortical carcinoma. Cancer Biotherapy and Radiopharmaceuticals. 2001; 16(4):289-95.
  5. Kumar T, Nigam JS, Sharma S, Kumari M, Pandey J. Uncommon Metastasizing Site of Adrenocortical Carcinoma. Cureus. 2021; 13(5):e15267.
  6. Takeuchi S, Balachandran A, Habra MA, Phan AT, Bassett RL, Macapinlac HA, et all. Impact of 18F-FDG PET/CT on the management of adrenocortical carcinoma: analysis of 106 patients. European journal of nuclear medicine and molecular imaging. 2014; 41(11):2066-73.
  7. Ardito A, Massaglia C, Pelosi E, Zaggia B, Basile V, Brambilla R, et all. 18F-FDG PET/CT in the post-operative monitoring of patients with adrenocortical carcinoma. Eur J Endocrinol. 2015; 173(6):749-56.
  8. Bergenstal DH. Regression of adrenal cancer and suppression of adrenal function in man by o, p'DDD. Transactions of the Association of American Physicians. 1959; 72:341-50.
  9. Paragliola RM, Torino F, Papi G, Locantore P, Pontecorvi A, Corsello SM. Role of mitotane in adrenocortical carcinoma–review and state of the art. European endocrinology. 2018; 14(2):62.
  10. Terzolo M, Angeli A, Fassnacht M, Daffara F, Tauchmanova L, Conton PA, et all. Adjuvant mitotane treatment for adrenocortical carcinoma. New England Journal of Medicine. 2007; 356(23):2372-80.
  11. Dong A, Cui Y, Wang Y, Zuo C, Bai Y. 18F-FDG PET/CT of adrenal lesions. American Journal of Roentgenology. 2014; 203(2): 245-52.
  12. Kiseljak-Vassiliades K, Bancos I, Hamrahian A, Habra MA, Vaidya A, Levine AC, et all. American Association of Clinical Endo-crinology Disease state clinical review on the evaluation and management of adrenocortical carcinoma in an adult: a practical approach. Endocrine Practice. 2020; 26(11):1366-83.
  13. Leboulleux S, Dromain C, Bonniaud G, Aupérin A, Caillou B, Lumbroso J, et all. Diagnostic and prognostic value of 18-fluorodeoxyglucose positron emission tomography in adrenocortical carcinoma: a prospective comparison with computed tomography. The Journal of Clinical Endo- crinology & Metabolism. 2006; 91(3): 920-5.
  14. Leboulleux S, Deandreis D, Escourrou C, Al Ghuzlan A, Bidault F, Auperin A, et all. Fluorodesoxyglucose uptake in the remaining adrenal glands during the follow-up of patients with adrenocortical carcinoma: do not consider it as malignancy. European Journal of Endocrinology. 2011; 164(1):89-94.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 11, Issue 2
July 2023
Pages 181-184

Files

Share

How to cite

Statistics