Korean J Radiol.  2010 Feb;11(1):126-130. 10.3348/kjr.2010.11.1.126.

MDCT and Gd-EOB-DTPA Enhanced MRI Findings of Adrenal Adenoma Arising from an Ectopic Adrenal Gland within the Liver: Radiologic-Pathologic Correlation

Affiliations
  • 1Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea. shkim@radcom.snu.ac.kr
  • 2Institute of Radiation Medicine, Seoul National University Hospital, Seoul 110-744, Korea.
  • 3Department of Pathology, Seoul National University Hospital, Seoul 110-744, Korea.

Abstract

We report a case of an adenoma arising from an ectopic adrenal gland mimicking a hepatocellular carcinoma in a heavy alcohol abuser. A MDCT showed a 2.7 low-attenuating nodule in segment VII of the liver through all CT phases. Compared to a precontrast image, however, a subtle enhancement was noted on the arterial phase CT image. On T1 weighted in- and opposed-phase MR images, an abundant fat component within the lesion was seen. Dynamic contrast-enhanced MR images after administration of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) more clearly depicted hypervascularity and wash-out of the lesion on arterial and portal phases, respectively. On delayed hepatobiliary phase MR images, obtained 20 minutes after Gd-EOB-DTPA administration, subtle uptake or retention of the contrast agent by the lesion was suspected. A tumorectomy was performed and adrenal adenoma from an ectopic adrenal gland within the liver was confirmed.

Keyword

Adrenal adenoma; Ectopic adrenal gland; Liver; Multi-detector computed tomography (MDCT); Magnetic resonance (MR)

MeSH Terms

Adrenal Cortex Neoplasms/*diagnosis
Adrenal Glands
Adrenocortical Adenoma/*diagnosis
Carcinoma, Hepatocellular/diagnosis
Choristoma/*diagnosis
*Contrast Media
Diagnosis, Differential
Gadolinium DTPA/*diagnostic use
Humans
Liver Neoplasms/*diagnosis
*Magnetic Resonance Imaging
Male
Middle Aged
*Tomography, X-Ray Computed

Figure

  • Fig. 1 Adrenal cortical adenoma arising from ectopic adrenal gland in liver. A. Transverse US image shows 2.5 cm subtle hypoechoic nodule (arrows) in segment VII of liver. B. On unenhanced CT image (left upper), lesion (arrow) shows marked low attenuation and its CT attenuation number was -4 HU, suggesting presence of fat within lesion. After contrast administration, lesion (arrow) showed heterogeneous enhancement on arterial (right upper) and portal (left lower) phase images, as well as clear washout on delayed (right lower) phase images. CT attenuation numbers were 29, 82, and 30 on three dynamic phases, respectively. C. On in- (left) and opposed (right) phase T1-weighted gradient recalled echo MR images, marked signal drop of lesion (arrow) as well as in liver is demonstrated, which suggests abundant fatty component within lesion and background liver, respectively. D. After Gd-EOB-DTPA administration, lesion (arrow) shows modest enhancement on arterial phase (right upper) compared to unenhanced image (left upper) and washout pattern on portal (left lower) and 3-minute equilibrium (right lower) phase images. E. Coronal MR images obtained 15 minutes after contrast injection clearly depict relationship between lesion (*) and right adrenal gland (arrowheads). Thin hyperintense capsule is clearly seen between two (in right image). F. Hepatobiliary phase image obtained 20 minutes after contrast injection demonstrates clear defect of lesion (arrow) compared to hyperintense background liver. However, subtle hyperintense focus (arrowhead) is seen off-center of lesion, indicating possibility of contrast uptake by tumor. Also note thin hyperintense rim (thin arrows) by hepatocytes at medial aspect of lesion, suggesting intrahepatic location of lesion. G. Gross pathologic specimen reveals 2.9 × 2.8 × 2.5 cm yellowish nodule surrounded by normal liver parenchyma and liver capsule (arrows). Note small foci of hemorrhage (arrowhead) off-center of lesion corresponding to area showing focal hyperintensity on 20-minute delayed MR images. H. Microscopic photograph (original magnification ×200, Hematoxylin & Eosin staining) shows well encapsulated nodule (A) surrounded by hepatocytes (H) and separated from adjacent perihepatic tissue (T) by fibrotic capsule (*) and hepatocytes. I. On low-power field microscopic photograph (original magnification ×40, Hematoxylin & Eosin staining), adrenal adenoma exhibits clear, lipid-laden cells arranged in sheets or nests (A) and contains organizing hematoma (arrows) in dilated vessel with inner vascular proliferation (*) corresponding to focal contrast uptake area on 20-minute delayed MR images.


Reference

1. Lack EE, Kozakewich HPW. Lack EE, editor. Embryonal, developmental anatomy, and selected aspects of non-neoplastic pathology. Pathology of the adrenal glands. 1990. New York, Edinburgh, London, Melbourne: Churchill Livingstone;1–74.
2. Busuttil A. Ectopic adrenal within the gall-bladder wall. J Pathol. 1974. 113:231–233.
3. Vestfrid MA. Ectopic adrenal cortex in neonatal liver. Histopathology. 1980. 4:669–672.
4. Honma K. Adreno-hepatic fusion. An autopsy study. Zentralbl Pathol. 1991. 137:117–122.
5. Honoré LH, O'Hara KE. Combined adrenorenal fusion and adrenohepatic adhesion: a case report with review of the literature and discussion of pathogenesis. J Urol. 1976. 115:323–325.
6. Woo HS, Lee KH, Park SY, Han HS, Yoon CJ, Kim YH. Adrenal cortical adenoma in adrenohepatic fusion tissue: a mimic of malignant hepatic tumor at CT. AJR Am J Roentgenol. 2007. 188:W246–W248.
7. Park BK, Kim CK, Jung BC, Suh YL. Cortical adenoma in adrenohepatic fusion tissue: clue to making a correct diagnosis at preoperative computed tomography examination. Eur Urol. 2009. [Epub ahead of print].
8. Bruix J, Sherman M. Practice Guidelines Committee. American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology. 2005. 42:1208–1236.
9. Caoili EM, Korobkin M, Francis IR, Cohan RH, Platt JF, Dunnick NR, et al. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology. 2002. 222:629–633.
10. Leibowitz J, Pertsemlidis D, Gabrilove JL. Recurrent Cushing's syndrome due to recurrent adrenocortical tumor--fragmentation or tumor in ectopic adrenal tissue? J Clin Endocrinol Metab. 1998. 83:3786–3789.
11. Medeiros LJ, Anasti J, Gardner KL, Pass HI, Nieman LK. Virilizing adrenal cortical neoplasm arising ectopically in the thorax. J Clin Endocrinol Metab. 1992. 75:1522–1525.
12. Gutowski WT 3rd, Gray G Jr. Ectopic adrenal in inguinal hernia sacs. J Urol. 1979. 121:353–354.
13. Stein SH, Latour F, Frost SS. Myelolipoma arising from ectopic adrenal cortex: case report and review of the literature. Am J Gastroenterol. 1986. 81:999–1001.
14. Maschler I, Rosenmann E, Ehrenfeld EN. Ectopic functioning adrenocortico-myelolipoma in longstanding Nelson's syndrome. Clin Endocrinol (Oxf). 1979. 10:493–497.
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