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Adrenocortical Carcinoma with Inferior Vena Cava Thrombus on 18F-FDG-PET-Computed Tomography
Abstract
Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignant neoplasm which can produce intravascular extension into the inferior vena cava (IVC) and can rarely extend into the right atrium. We describe the 18F Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography findings of a 57-year-old man diagnosed with ACC with IVC thrombus extending up to the right atrium.
Keywords: Adrenocortical carcinoma, FDG, inferior vena cava, PET-computed tomography, thrombus
A 57-year-old man presented to surgery outpatient department with intermittent abdominal pain in the right hypochondrium for 3 months. Contrast-enhanced computed tomography (CT) of the abdomen was advised which showed a heterogeneous mass with few necrotic areas measuring
~12.2 cm × 11.8 cm × 13 cm in the right suprarenal region with hypodense area in the intrahepatic inferior vena cava (IVC). On suspicion of adrenocortical carcinoma (ACC), biochemical tests were done, which showed elevated serum cortisol and Dihydroepiandosterone DHEA levels,
Sarthak Tripathy, Abhishek Behera, Arunav Kumar, Kishan Subudhi, Chandrasekhar Bal Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India
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How to cite this article: Tripathy S, Behera A, Kumar A, Subudhi K, Bal C. Adrenocortical carcinoma with inferior vena cava thrombus on 18F-FDG- PET-computed tomography. Indian J Nucl Med 2020;35:87-8.
Address for correspondence: Prof. Chandrasekhar Bal, Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail: csbal@hotmail.com
Received: 23-05-2019, Revised: 30-05-2019, Accepted: 09-07-2019, Published: 31-12-2019.
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Website: www.ijnm.in
DOI: 10.4103/ijnm.IJNM_107_19
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Tripathy, et al .: Adrenocortical carcinoma with IVC thrombus on 18F-FDG-PET-CT
suggestive of secretory activity of the tumor. Considering surgery as the curative treatment option, the patient was referred for 18F-FDG-PET-CT scan to rule out any distant metastasis. PET-CT findings revealed a large FDG avid heterogenous right suprarenal mass [Figure la-j]. Right adrenal was not visualized separately. FDG avid IVC thrombus (Standard uptake volume SUV _~ 7.6) extending up to the right atrium was also seen [Figure le-j dashed black and white arrows]. Fine-needle aspiration cytology of the mass was consistent with features of ACC. The patient underwent right adrenalectomy with IVC thrombectomy, and the histopathology was consistent with ACC.
ACC is a rare and aggressive neoplasm with a very poor 5-year survival rate of 15%-44% in a series reported in the literature.[1-3] These neoplasms tend to grow very rapidly with common sites of metastases being liver, lung, and local invasion into kidneys, renal veins, and IVC.[4] Few case reports have highlighted the pattern of FDG uptake in IVC thrombus in case of ACC.[5,6] Sharma et al. in their series of 24 patients have demonstrated that avidity of FDG quantitatively assessed by SUV_ can differentiate between a benign and malignant tumor thrombus.[7] Most of the max malignant thrombus had a SUV_ of >6.0, and in our case also, SUV __ of 7.6 was suggestive of a malignant tumor max thrombus. Our case reiterates the fact that 18F-FDG-PET-CT can be helpful in the detection of primary tumor with local venous and visceral invasion as well as distant metastases in cases of ACC.
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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and
other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
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Conflicts of interest
There are no conflicts of interest.
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