CLINICAL NUCLEAR MEDICINE
The Official Publication of the American College of Nuclear Medicine
Full text available at www.nuclearmed.com
OVID
ACNM
50
Wolters Kluwer
Evaluation of Adrenocortical Carcinoma in an Infant Using Ga-67 Scintigraphy
De VRIES LIAT M.D .; BAR-SEVER, ZVI M.D .; ZIV, NITSA M.D .; SCHWARZ, MICHAEL M.D .; HARDOFF, RUTH M.D., D.Sc.
Clinical Nuclear MedicineClinical Nuclear Medicine. 25:p 394-395, May 2000.
Author Information
From the Department of Pediatric Endocrinology,* Schneider Children Medical Center, Department of Nuclear Medicine, ¡ Rabin Medical Center, Beilinson Campus, and the Department of Imaging,¿ Schneider Children Medical Center, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Reprint requests: Ruth Hardoff, M.D., D.SC., Department of Nuclear Medicine, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 Israel. E-mail: harduf@post.tau.ac.il
CLINICAL NUCLEAR MEDICINE publishes in each issue a section of references to articles of interest to its readers taken from the world medical literature.
Articles below were selected from listings received through March 7, 1999.
Slavic and Oriental language articles have English summaries unless marked with an asterisk after language abbreviation.
Abstract
An infant with adrenocortical carcinoma revealed by Ga-67 scintigraphy is described. Adrenocortical carcinoma is a rare neoplasm, with an annual prevalence of two new cases per million population. An English literature search revealed only a few cases detected by Ga-67, with only one child described. Most children with adrenocortical carcinoma have functional tumors, so clinical presentation consists of virilizing signs in girls and pseudo-precocious puberty in boys, Cushing syndrome, accelerated growth, advanced bone age, and hypertension. Diagnosis is established by different imaging methods, combined with elevated serum adrenal steroid levels. Complete surgical resection is the preferred treatment.
31533883
GING DEPARTMENT C.M.C.
CINELOOP (R) REV
5.00 MHZ
50.12 /
3 C7 E4
8.8 HZ
RTK
1
5.06 cm
2. 4.70 cm
SET to activate alternate cursor.
A 1-year-old girl was examined because of virilization consisting of clitoromegaly and pubic hair. Adrenal androgens were markedly elevated, including androstendione, 29.5 nmol/l (normal range, 0.21- 0.52); dehydroepiandrostendione sulphate, >27 µmol/l (0.06-0.54); testosterone, 4.4 nmol/1 (0.07-0.14); and 11-deoxycortisol, 37 nmol/l (2-28.8). Homovanillic acid and vanilmandelic acid were within the normal range. An ultrasonographic study showed a 7 x 5 cm (on some planes) solid mass anterior and cranial to the right kidney. Calcifications were observed at the periphery of the mass, with no evidence of invasion to the right kidney.
FIGURE 2
SW 55
ST 1
2
5 cr
R
I
C* W±
Computed tomography of the abdomen with intravenous and enteral contrast media showed a 6 x 7.5 cm mass cranial to the right kidney with coarse peripheral calcifications and areas of liquefaction. The right adrenal gland was not demonstrated. The right lobe of the liver, adjacent intestine, and head of the pancreas were displaced by the tumor, but no tumor invasion was evident. The right kidney was displaced and twisted by the tumor, whereas renal vessels were not shown to be involved. Neither lymph node enlargement nor other abdominal masses were observed. The clinical, laboratory, and imaging data supported a diagnosis of adrenocortical carcinoma (1-3).
a
b
C
Ga-67 scintigraphy was requested as a baseline study to determine whether this tumor was Ga-67 avid. Ga-67 scintigraphy showed intense uptake corresponding to the right adrenal tumor. (a) Anterior view; (b) posterior view; (c) right anterior oblique view. Ga-67 scintigraphy is not essential to the initial diagnosis, but a baseline study may confirm Ga-67 uptake of the tumor, establishing its use as a sensitive follow-up method. It is often difficult to distinguish histologically between benign and malignant adrenocortical tumor, particularly in children. Because remote metastases have been shown to be Ga-67 positive in Ga-67-avid tumors (4,5), the scan may be valuable for diagnosis and follow-up. The tumor was resected and the histologic findings were consistent with adrenocortical carcinoma.
FIGURE 4
Planar and SPECT (not shown) Ga-67 scintigraphy were repeated 6 months later and showed no evidence of abnormal uptale.
Back to Top
References
1. Moore L, Barker AP, Byard AJ, et al: Adrenal cortical tumors in childhood- Clinicopathological features of six cases. Pathology 23:94, 1991.
2. Ribiero RC, Neto RS, Schell MJ, et al: Adrenocortical carcinoma in children: A study of 40 cases. J Clin Oncol 8:67, 1990.
3. Daneman A, Chan HSL, Martin J: Adrenal carcinoma and adenoma in children: A review of 17 patients. Pediatr Radiol 13:11, 1983.
4. Ward FT, Anderson JH, Jelnik J, et al: Localization of metastatic adrenal cortical carcinoma with Ga-67. Clin Nucl Med 16:117, 1991.
5. Howman-Giles R, Dalla-Pozza L, Uren R: Gallium-67 scintigraphy in a child with adrenocortical carcinoma. Clin Nucl Med 18:642, 1993.
Keywords:
Adrenocortical Carcinoma; Ga-67.
C 2000 Lippincott Williams & Wilkins, Inc.