Androgen Producing Giant Adrenocortical Carcinoma with Remarkable Accumulation of ⁶⁷Galium Citrate

We present a patient with androgen-producing giant adrenocortical carcinoma without clinical symptoms.A 41-year-old man was admitted to Toho University Hospital for evaluation of right abdominal pain and cough. A large abdominal mass was detected in the right upper abdomen. Marked increases in urinary 17KS excretion and in blood DHEA and DHEA sulfate levels were observed. A computer tomographic abdominal scan demonstrated a tumor (16×14×15cm) with irregular density above the right kidney. Gamma camera imaging following the intravenous injection of 1 mCi of 67galium citrate revealed a marked isotopic uptake in the tumor. From these endocrinological and anatomical data we diagnosed an adrenocortical carcinoma. During an unilateral right adrenalectomy, a 22×14×22cm, 2550g encapsulated adrenal tumor was removed. The tumor consisted mainly of small eosinophilic cells with nuclear pleomorphism and partly of large clear cells. Areas of necrosis and mitosis were obseved. These findings are consistent with adrenocortical carcinoma. This adrenocortical carcinoma accumulated a marked amount of 67galium citrate, and we reviewed the usefullness of 67galium citrate scintigraphy for the diagnosis of different adrenal tumors.