Roland Kreissig ☒ Holger Amthauer Heiko Krude Peter Steinmueller Christian Stroszczynski Norbert Hosten Annette Grueters Roland Felix
Received: 26 April 1999 Accepted: 28 December 1999 R. Kreissig ☒ . H. Amthauer · C. Stroszczynski · N. Hosten · R. Felix Radiology Clinic, Charité, Campus Virchow-Klinikum, Medical Faculty of Humboldt-University, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
H. Krude . A. Grueters
Pediatric Endocrinology, Children’s Clinic, Charité, Campus Virchow-Klinikum, Medical Faculty of Humboldt-University, Berlin, Augustenburger Platz 1, 13 353 Berlin, Germany
P. Steinmueller
Clinic for General and Transplantation Surgery, Charité, Campus Virchow- Klinikum, Medical Faculty of Humboldt- University, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
A 13-year-old boy was found to have a huge right adrenal tumour as an incidental find- ing during US of the kidneys for a different reason. He had elevated levels of cortisol, dihydroandrostendion and neuronespecific enolase. MRI, CT, angiography and bone scintigraphy showed an adrenal tumour
The use of FDG-PET and CT for the staging of adrenocortical carcinoma in children
with a solitary liver metastasis, represent- ing stage IV disease. The primary tumour and liver metastasis were resected, and the histological diagnosis was moderately dif- ferentiated adrenocortical carcinoma.
One month post-surgery and before the start of adjuvant mitotane therapy, FDG- PET was performed to exclude further me- tastases (Fig. 1). This showed increased glu- cose utilisation in the right paravertebral region with a maximum standard uptake value (SUV) of 6.1. CT (Fig.2) revealed paravertebral soft tissue tumour at the level of L4 with destruction of the adjacent transverse process. Histology following fur- ther resection confirmed metastatic adre- nal carcinoma.
The prognosis in metastatic adrenal cor- tical carcinoma is very poor [1]. The most common locations for distant metastases are lung, liver and skeleton, but various un- usual locations have been reported. Al- though CT and MRI seem to be sufficient in most patients as the screening method for the most common lung and liver me- tastases, unusual metastases are very likely to escape the routine diagnostic algorithm [2].
FDG-PET imaging in adults seems to be able to differentiate malignant from be- nign adrenal lesions [3, 4]. So far, there are no data concerning the staging of adreno- cortical carcinomas in children. In our pa- tient FDG-PET was a satisfactory tool for metastasis screening. Primary screening
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with PET, followed by morphologic imag- ing with CT or MRI, may be a suitable, cost effective and non-invasive option, es- pecially in children and infants. The esti- mated effective equivalent dose of 6 mSv corresponds to an intermediate radiation exposure compared with other radiological or nuclear medicine investigations. Since complete resection of the tumour and its metastases seems to be crucial for patient outcome, FDG-PET may have an impact on life expectancy.
References
1. Sabbaga CC, Avilla SG. Schulz C, et al (1993) Adrenocortical carcinoma in children: clinical aspects and prognosis. J Pediatr Surg 28: 841-843
2. Evans HL, Vassilopoulou-Sellin R (1996) Adrenal cortical neoplasms. A study of 56 cases. Am J Clin Pathol 105: 76-86
3. Maurea S, Mainolfi C, Wang H, et al (1996) Positron emission tomography (PET) with fludeoxyglucose F 18 in the study of adrenal masses: comparison of benign and malignant lesions. Radiol Med (Torino) 92: 782-787
4. Boland GW, Goldberg MA, Lee MJ, et al (1995) Indeterminate adrenal mass in patients with cancer: evaluation at PET with 2-[F-18]-fluoro-2-deoxy-D- glucose. Radiology 194: 131-134