Case 6

This is a contrast enhanced CT study showing a large mass of heterogeneous density in the left side of the retroperitoneum – it displaces the left kidney caudally and the stomach and pancreas anteriorly. The left adrenal gland cannot be visualised separately from the mass. The mass shows avid peripheral heterogeneous enhancement on the arterial phase, and persistent enhancement on the portal venous phase with a large, central non-enhancing component which indicates necrosis.

There are a few prominent peri-aortic and common iliac lymph nodes.

There is no calcification and I cannot appreciate invasion of adjacent or local structures, or any distant spread.

The features are characteristic of a malignant neoplasm of the adrenal gland.

I would raise this case for discussion at endocrine surgery MDT, in order to discuss image guided biopsy and potential resectability.