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A black adrenal adenoma difficult to be differentiated from a malignant adrenal tumor by CT, MRI, scintigraphy and FDG PET/CT examinations

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Abstract

Black adrenal adenoma (BAA) is an adrenal adenoma which contains lipofuscin and has a black or brown appearance. Preoperative diagnosis of BAA is difficult because it is diagnosed by pathologic findings. We report a case of an incidentally discovered non-hyperfunctioning BAA in the left adrenal gland of a 58-year-old man. It showed an oval lipid-poor mass, 3 cm × 2 cm in size on computed tomography (CT) and magnetic resonance imaging (MRI), no avid uptake of 131I-norcholesterol and 123I-meta-iodobenzylguanidine (MIBG) on scintigraphy, and intense avid uptake of 18F-fluorodeoxyglucose (FDG) on positron emission tomography–CT (PET/CT). FDG PET/CT showed that it was a hypermetabolic lesion, more intense than the activity of the liver, and the maximum standardized uptake value was 5.6 on 1-h early imaging and 8.3 on 2-h delayed imaging, suggesting a malignant tumor. BAA is a clinically rare benign adrenal adenoma, but it should be kept in mind that BAA may exhibit false-positive results for malignancy or inconclusive results for benignity with modern imaging modalities including CT, MRI, adrenal scintigraphy with radiolabelled cholesterol and radiolabelled MIBG, and FDG-PET like this case.

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References

  1. Robinson MJ, Pardo V, Rywlin AM. Pigmented nodules (black adenomas) of the adrenal. An autopsy study of incidence, morphology, and function. Hum Pathol. 1972;3:317–25.

    Article  PubMed  CAS  Google Scholar 

  2. Komiya I, Takasu N, Aizawa T, Yamada T, Koizumi Y, Hashizume K, et al. Black (or brown) adrenal cortical adenoma: its characteristic features on computed tomography and endocrine data. J Clin Endocrinol Metab. 1985;61:711–7.

    Article  PubMed  CAS  Google Scholar 

  3. Reschini E, Baldini M, Cantalamessa. A black adrenocortical adenoma causing Cushing’s syndrome not imaged by radiocholesterol scintigraphy. Eur J Nucl Med. 1990;17:185–7.

    Article  PubMed  CAS  Google Scholar 

  4. Kameyama K, Takami H. Pigmented granules in functional black adenoma of the adrenal gland: a histochemical and ultrastructural study. Endocr Pathol. 1999;10:353–7.

    Article  PubMed  Google Scholar 

  5. Dixon RM, Lieberman LM, Gould HR, Hafez GR. [131I]Iodocholesterol scintiscan and a rare “functional” black adenoma of the adrenal cortex. J Nucl Med. 1983;24:505–7.

    PubMed  CAS  Google Scholar 

  6. Nomura K, Saito H, Aiba M, Iihara M, Obara T, Takano K. Cushing’s syndrome due to bilateral adrenocortical adenomas with unique histological features. Endocr J. 2003;50:155–62.

    Article  PubMed  Google Scholar 

  7. Ambrosi B, Colombo P, Faglia G. Cushing’s syndrome due to a black adenoma of the adrenal gland: lack of tumour visualization by radiocholesterol scintigraphy. Eur J Nucl Med. 1994;21:1367–8.

    Article  PubMed  CAS  Google Scholar 

  8. Mimou N, Sakato S, Nakabayashi H, Saito Z, Takeda R, Matsubara F. Cushing’s syndrome associated with bilateral adrenal adenomas. Acta Endocrinol (Copenh). 1985;108:245–54.

    CAS  Google Scholar 

  9. Okura T, Miyoshi K, Watanabe S, Kurata M, Irita J, Manabe S, et al. Coexistence of three distinct adrenal tumors in the same adrenal gland in a patient with primary alsdosteronism and preclinical Cushing’s syndrome. Clin Exp Nephrol. 2006;10:127–30.

    Article  PubMed  Google Scholar 

  10. Inomoto C, Sato H, Kanai G, Hirukawa T, Shoji S, Terauchi T, et al. Black adrenal adenoma causing preclinical Cushing’s syndrome. Tokai J Exp Clin Med. 2010;35:57–61.

    PubMed  CAS  Google Scholar 

  11. Tokunaga H, Miyamura N, Sasaki K, Yoshizato K, Itasaka M, Nakamaru K, et al. Preclinical Cushing’s syndrome resulting from black adrenal adenoma. A case report. Horm Res. 2004;62:60–6.

    Article  CAS  Google Scholar 

  12. Prince EA, Yoo DC, DeLellis RA, Mayo-Smith WW. CT and PET appearance of a pigmented “black” adrenal adenoma in a patient with lung cancer. Clin Radiol. 2007;62:1229–31.

    Article  PubMed  CAS  Google Scholar 

  13. Kamiyama T, Fukukura Y, Yoneyama T, Takumi K, Nakajo M. Distinguishing adrenal adenomas from nonadenomas: combined use of diagnostic parameters of unenhanced and short 5-minute dynamic enhanced CT protocol. Radiology. 2009;250:474–81.

    Article  PubMed  Google Scholar 

  14. Lau SK, Weiss LM. The Weiss system for evaluating adrenocortical neoplasms: 25 years later. Hum Pathol. 2009;40:757–68.

    Article  PubMed  Google Scholar 

  15. Song JH, Chaudhry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1049 consecutive adrenal masses in patients with no known malignancy. AJR Am J Roentgenol. 2008;190:1163–8.

    Article  PubMed  Google Scholar 

  16. Blake MA, Cronin CG, Boland GW. Adrenal imaging. AJR Am J Roentgenol. 2010;194:1450–60.

    Article  PubMed  Google Scholar 

  17. Yin D. Biochemical basis of lipofuscin, ceroid, and age pigment-like fluorophores. Free Radic Biol Med. 1996;21:871–88.

    Article  PubMed  CAS  Google Scholar 

  18. Korobkin M, Giordano TJ, Brodeur FJ, Francis IR, Siegelman ES, Quint LE, et al. Adrenal adenomas: relationship between histologic lipid and CT and MRI findings. Radiology. 1996;200:743–7.

    PubMed  CAS  Google Scholar 

  19. Nakajo M, Nakabeppu Y, Yonekura R, Iwashita S, Goto T. The role of adrenocortical scintigraphy in the evaluation of unilateral incidentally discovered adrenal and juxtaadrenal masses. Ann Nucl Med. 1993;7:157–66.

    Article  PubMed  CAS  Google Scholar 

  20. Tani A, Nakajo M, Tsuchimochi S, Nakabeppu Y, Umanodan T. Adrenal incidentalomas showing unilateral concordant visualization by adrenocortical scintigraphy: comparison with adenomas in Cushing’s syndrome. Ann Nucl Med. 2000;14:205–12.

    Article  PubMed  CAS  Google Scholar 

  21. Jacobson AF, Deng H, Lombard J, Lessig HJ, Black RR. 123I-meta-iodobenzylguanidine scintigraphy for the detection of neuroblastoma and pheochromocytoma: results of a meta-analysis. J Clin Endocrinol Metab. 2010;95:2596–606.

    Article  PubMed  CAS  Google Scholar 

  22. Boland GW, Blake MA, Holalkere NS, Hahn PF. PET/CT for the characterization of adrenal masses in patients with cancer: qualitative versus quantitative accuracy in 150 consecutive patients. AJR Am J Roentgenol. 2009;192:956–62.

    Article  PubMed  Google Scholar 

  23. Bagheri B, Maurer AH, Cone L, Doss M, Adler L. Characterization of the normal adrenal gland with 18F-FDG PET/CT. J Nucl Med. 2004;45:1340–3.

    PubMed  Google Scholar 

  24. Yun M, Kim W, Alnafisi N, Lacorte L, Jang S, Alavi A. 18F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J Nucl Med. 2001;42:1795–9.

    PubMed  CAS  Google Scholar 

  25. Kumar R, Xiu Y, Yu JQ, Takalkar A, El-Haddad G, Potenta S, et al. 18F-FDG PET in evaluation of adrenal lesions in patients with lung cancer. J Nucl Med. 2004;45:2058–62.

    PubMed  Google Scholar 

  26. Blake MA, Slattery JM, Kalra MK, Halpern EF, Fischman AJ, Mueller PR, et al. Adrenal lesions: characterization with fused PET/CT image in patients with proved or suspected malignancy-initial experience. Radiology. 2006;238:970–7.

    Article  PubMed  Google Scholar 

  27. Nakamoto Y, Higashi T, Sakahara H, Tamaki N, Kogire M, Doi R, et al. Delayed 18F-fluoro-2-deoxy-d-glucose positron emission tomography scan for differentiation between malignant and benign lesions in the pancreas. Cancer. 2000;89:2547–54.

    Article  PubMed  CAS  Google Scholar 

  28. Xiu Y, Bhutani C, Dhurairaj T, Yu JQ, Dadparvar S, Reddy S, et al. Dual-time point FDG PET imaging in the evaluation of pulmonary nodules with minimally increased metabolic activity. Clin Nucl Med. 2007;32:101–5.

    Article  PubMed  Google Scholar 

  29. Rao SK, Caride VJ, Ponn R, Giakovis E, Lee SH. F-18 fluorodeoxyglucose positron emission tomography-positive benign adrenal cortical adenoma: imaging features and pathologic correlation. Clin Nucl Med. 2004;29:300–2.

    Article  PubMed  Google Scholar 

  30. Shimizu A, Oriuchi N, Tsushima Y, Higuchi T, Aoki J, Endo K. High [18F] 2-fluoro-2-deoxy-d-glucose (FDG) uptake of adrenocortical adenoma showing subclinical Cushing’s syndrome. Ann Nucl Med. 2003;17:403–6.

    Article  PubMed  Google Scholar 

  31. Gupta NC, Graeber GM, Tamim WJ, Rogers JS, Irisari L, Bishop HA. Clinical utility of PET-FDG imaging in differentiation of benign from malignant adrenal masses in lung cancer. Clin Lung Cancer. 2001;3:59–64.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan

    Masatoyo Nakajo & Masayuki Nakajo

  2. Department of Radiology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan

    Yoriko Kajiya & Atsushi Tani

  3. Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan

    Masashi Tsuruta, Satoshi Sugita & Shunsaku Fushitani

  4. Department of Tumor Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan

    Yoshihisa Umekita

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  1. Masatoyo Nakajo
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  2. Masayuki Nakajo
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  3. Yoriko Kajiya
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  4. Atsushi Tani
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Correspondence to Masatoyo Nakajo.

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Nakajo, M., Nakajo, M., Kajiya, Y. et al. A black adrenal adenoma difficult to be differentiated from a malignant adrenal tumor by CT, MRI, scintigraphy and FDG PET/CT examinations. Ann Nucl Med 25, 812–817 (2011). https://doi.org/10.1007/s12149-011-0535-6

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  • DOI: https://doi.org/10.1007/s12149-011-0535-6

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