Öz
Amaç: Adrenal kortikal karsinomun (AKK) Bilgisayarlı Tomografi (BT) görüntüleme özelliklerini araştırmak.
Gereç ve yöntem: Patolojik olarak AKK tanısı almış 15 hastanın (K/E: 8/7, ortanca [aralık]: 53 yıl [31-74 yıl]) kalitatif ve kantitatif BT bulguları retrospektif olarak değerlendirildi. Lezyonların fonksiyonel durumlarına klinik notlardan ulaşıldı.
Bulgular: Hastaların patolojik tanısı cerrahi (n=12) veya cerrahi eşliğinde biyopsi (n=3) ile konulmuştu. 9 lezyon (%60) fonksiyonel, 6 lezyon (%40) non-fonksiyoneldi. Fonksiyonel lezyonların 5’i androjen, 4’ü kortizon üretmekteydi. Kalitatif değerlendirmede 13 lezyon (%93) nekroz, 3 lezyon (%20) kalsifikasyon ve 1 lezyon (%7) makroskobik yağ içeriyordu. Lezyonların tamamı iyi sınırlı olup heterojen kontrastlanmaktaydı. Lezyonların ortanca (aralık) boyutu 9,7 cm (6.3-18 cm) idi. Prekontrast, arteriyel faz, portal faz ve geç faz ortanca (aralık) dansite değerleri sırasıyla şöyleydi: 34 HU (22-41 HU), 46 HU (27-65 HU), 60 HU (29-90 HU), 48 HU (28-64 HU). 9 hastada 15. dakika geç faz elde olunmuştu. Ortanca (aralık) mutlak (MKYY) ve bağıl (BKYY) kontrast yıkanma yüzdeleri sırasıyla şöyleydi: %48,8 (%-3.8-62.5) ve %21 (%-1.5-30.8). Sadece bir lezyonun MKYY değeri %60’in üzerindeydi.
Sonuç: AKK’lar BT’de genellikle büyük (>6cm), iyi sınırlı, heterojen kontrastlanan, nekrotik kitleler şeklinde görülür. Makroskobik yağ ve kalsifikasyon içerebilir ve geç faz imajlarda sınırlı kontrast yıkanması gösterirler.
Anahtar Kelimeler
adrenal kortikal karsinom bilgisayarli tomografi kontrast yıkanma yüzdesi
Proje Numarası
PA13-0789
Teşekkür
Sayın editör, ‘Adrenal Kortikal Karsinom’da Bilgisayarlı Tomografi Görüntüleme Bulguları’ başlıklı makalemi Genel Tip Dergisi’ sistemine yüklüyorum. Bu makalede nadir görülen Adrenal Kortikal Karsinom’un Bilgisayarlı Tomografi görüntüleme bulgularını araştırdık. Daha önce literatürde bildirilmemiş olan kontrast yıkanma yüzdelerini raporladık. Araştırmamızın tamamı veya bir kısmi daha önce başka bir dergide yayınlanmamıştır. Değerli vaktinizi ayırdığınız için şimdiden teşekkür ederim. Saygılarımla, Dr. Öğretim Üyesi Emre Altınmakas Koç Üniversitesi Hastanesi Radyoloji AD emrealtinmakas@gmail.com Tel: 532 462 8101
Kaynakça
- Reznek RH, Narayanan P. Primary adrenal malignancy. Husband & Reznek’s imaging in oncology, 3rd ed. London, UK: Informa Healthcare-2010;280–298
- Latronico, Ana C., and George P. Chrousos. "Adrenocortical tumors." The Journal of Clinical Endocrinology & Metabolism 82.5-1997; 1317-1324.
- Wooten MD, King DK. Adrenal cortical carcinoma: epidemiology and treatment with mitotane and a review of the literature. Cancer-1993; 72: 3145–3155
- Ng L, Libertino JM. Adrenocortical carcinoma: diagnosis, evaluation and treatment. J Urol-2003; 169:5–11
- Bharwani, N., Rockall, A. G., Sahdev, A. et al. Adrenocortical carcinoma: the range of appearances on CT and MRI. American journal of roentgenology-2011;196(6), W706-W714
- Altinmakas, E., Guo, M., Kundu, U. R., Habra MA, Ng CS . Computed tomography and 18F-fluorodeoxyglucose positron emission tomography/computed tomography findings in adrenal candidiasis and histoplasmosis: two cases. Clinical imaging-2015;39(6), 1115-1118.
- Altinmakas, E., Üçışık-Keser, F. E., Medeiros, Ng CS CT and 18F-FDG-PET-CT Findings in Secondary Adrenal Lymphoma with Pathologic Correlation. Academic radiology-2019;26(6), e108-e114.
- Altinmakas, E., Perrier, N. D., Grubbs, E. G., Lee EJ, Prieto VG, Ng CS Diagnostic performance of adrenal CT in the differentiation of adenoma and pheochromocytoma. Acta Radiologica-2020;61(8), 1080-1086.
- Korobkin M, Brodeur FJ, Francis IR, Quint LE, Dunnick NR, Goodsitt M Delayed enhanced CT for differentiation of benign from malignant adrenal masses. Radiology-1996; 200:737–742
- Szolar, D. H., Korobkin, M., Reittner, P. et al. Adrenocortical carcinomas and adrenal pheochromocytomas: mass and enhancement loss evaluation at delayed contrast-enhanced CT. Radiology-2005; 234(2), 479-485.
- Petersenn, S., Richter, P. A., Broemel, T. et al. Computed tomography criteria for discrimination of adrenal adenomas and adrenocortical carcinomas: analysis of the German ACC registry. Eur J Endocrinol-2015; 172(4), 415-22.
- Allolio B, Fassnacht M. Clinical review: adrenocortical carcinoma—clinical update. J Clin Endocrinol Metab-2006; 91:2027–2037
- Egbert, N., Elsayes, K. M., Azar, S., Caouli M. Computed tomography of adrenocortical carcinoma containing macroscopic fat. Cancer Imaging,-2010;10(1), 198.
- Heye, S., Woestenborghs, H., Van Kerkhove, F., Oyen R Adrenocortical carcinoma with fat inclusion: case report. Abdominal imaging-2005;30(5), 641-643.
- Fishman, E. K., Deutch, B. M., Hartman, D. S., Goldman SM, Zerhouni EA, Siegelman SS. Primary adrenocortical carcinoma: CT evaluation with clinical correlation. American Journal of Roentgenology-1987; 148(3), 531-535.
- Slattery, J. M., Blake, M. A., Kalra, M. K. et al. Adrenocortical carcinoma: contrast washout characteristics on CT. American Journal of Roentgenology-2006; 187(1), W21-W24.
- Shin, Y. R., & Kim, K. A. Imaging features of various adrenal neoplastic lesions on radiologic and nuclear medicine imaging. American Journal of Roentgenology-2015; 205(3), 554-563.
Öz
Objective: To evaluate computed tomography (CT) imaging manifestations of adrenocortical carcinomas (ACC).
Materials and Methods: Qualitative, and quantitative CT findings of 15 patients (Eight women, seven men; median age [range], 53 years [31-74 years]) with 15 pathologically proven ACCs were retrospectively analyzed. Lesions' functional status were captured through clinical notes.
Results: Pathologic diagnosis was based on either surgery (n=12) or surgical biopsy (n=3). Nine lesions were functioning (60%, androgen [n=5] or cortisol [n=4]) and 6 lesions were non-functioning (40%). In qualitative CT analysis, 13 (93%), 3 (20%), and 1 (7%) lesion had necrosis, calcification and macroscopic fat, respectively. All lesions showed well-defined borders and heterogeneous enhancement. Median [range] density on precontrast, arterial phase, portal phase, and 15-minute delay phase were 34 HU (22-41 HU), 46 HU (27-65 HU), 60 HU (29-90 HU), and 48 HU (28-64 HU), respectively. Nine patients had 15-minute delay phase available. Median (range) absolute and relative percentage of enhancement wash-out (APEW and RPEW) values were 48.8% (-3.8-62.5%) and 21% (-1.5-30.8%). Only one lesion had an APEW above %60.
Conclusion: ACCs usually manifest as, large (>6cm), well-defined, heterogeneously enhancing, necrotic masses on CT. These lesions may include calcification or macroscopic fat and tend to show limited wash-out on delay phase CT.
Anahtar Kelimeler
adrenocortical carcinoma computed tomography percentage of enhancement wash-out
Proje Numarası
PA13-0789
Kaynakça
- Reznek RH, Narayanan P. Primary adrenal malignancy. Husband & Reznek’s imaging in oncology, 3rd ed. London, UK: Informa Healthcare-2010;280–298
- Latronico, Ana C., and George P. Chrousos. "Adrenocortical tumors." The Journal of Clinical Endocrinology & Metabolism 82.5-1997; 1317-1324.
- Wooten MD, King DK. Adrenal cortical carcinoma: epidemiology and treatment with mitotane and a review of the literature. Cancer-1993; 72: 3145–3155
- Ng L, Libertino JM. Adrenocortical carcinoma: diagnosis, evaluation and treatment. J Urol-2003; 169:5–11
- Bharwani, N., Rockall, A. G., Sahdev, A. et al. Adrenocortical carcinoma: the range of appearances on CT and MRI. American journal of roentgenology-2011;196(6), W706-W714
- Altinmakas, E., Guo, M., Kundu, U. R., Habra MA, Ng CS . Computed tomography and 18F-fluorodeoxyglucose positron emission tomography/computed tomography findings in adrenal candidiasis and histoplasmosis: two cases. Clinical imaging-2015;39(6), 1115-1118.
- Altinmakas, E., Üçışık-Keser, F. E., Medeiros, Ng CS CT and 18F-FDG-PET-CT Findings in Secondary Adrenal Lymphoma with Pathologic Correlation. Academic radiology-2019;26(6), e108-e114.
- Altinmakas, E., Perrier, N. D., Grubbs, E. G., Lee EJ, Prieto VG, Ng CS Diagnostic performance of adrenal CT in the differentiation of adenoma and pheochromocytoma. Acta Radiologica-2020;61(8), 1080-1086.
- Korobkin M, Brodeur FJ, Francis IR, Quint LE, Dunnick NR, Goodsitt M Delayed enhanced CT for differentiation of benign from malignant adrenal masses. Radiology-1996; 200:737–742
- Szolar, D. H., Korobkin, M., Reittner, P. et al. Adrenocortical carcinomas and adrenal pheochromocytomas: mass and enhancement loss evaluation at delayed contrast-enhanced CT. Radiology-2005; 234(2), 479-485.
- Petersenn, S., Richter, P. A., Broemel, T. et al. Computed tomography criteria for discrimination of adrenal adenomas and adrenocortical carcinomas: analysis of the German ACC registry. Eur J Endocrinol-2015; 172(4), 415-22.
- Allolio B, Fassnacht M. Clinical review: adrenocortical carcinoma—clinical update. J Clin Endocrinol Metab-2006; 91:2027–2037
- Egbert, N., Elsayes, K. M., Azar, S., Caouli M. Computed tomography of adrenocortical carcinoma containing macroscopic fat. Cancer Imaging,-2010;10(1), 198.
- Heye, S., Woestenborghs, H., Van Kerkhove, F., Oyen R Adrenocortical carcinoma with fat inclusion: case report. Abdominal imaging-2005;30(5), 641-643.
- Fishman, E. K., Deutch, B. M., Hartman, D. S., Goldman SM, Zerhouni EA, Siegelman SS. Primary adrenocortical carcinoma: CT evaluation with clinical correlation. American Journal of Roentgenology-1987; 148(3), 531-535.
- Slattery, J. M., Blake, M. A., Kalra, M. K. et al. Adrenocortical carcinoma: contrast washout characteristics on CT. American Journal of Roentgenology-2006; 187(1), W21-W24.
- Shin, Y. R., & Kim, K. A. Imaging features of various adrenal neoplastic lesions on radiologic and nuclear medicine imaging. American Journal of Roentgenology-2015; 205(3), 554-563.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Original Article |
| Yazarlar | |
| Proje Numarası | PA13-0789 |
| Yayımlanma Tarihi | 20 Eylül 2021 |
| Gönderilme Tarihi | 29 Temmuz 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 31 Sayı: 3 |
Genel Tıp Dergisi Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı (CC BY NC) ile lisanslanmıştır.