Adrenal Incidentaloma Presenting as Carcinoma of Unknown Primary

Abstract

An adrenal incidentaloma is an adrenal mass, generally 1 cm or more in diameter that is discovered serendipitously during a radiologic examination performed for indication other than evaluation for adrenal disease. With the increasing use of ultrasonography, computerized tomography, and magnetic resonance tomography, an adrenal mass may be identified more frequently. Most adrenal incidentalomas are nonfunctioning adenomas. Metastatic cancer should be considered in patients with known malignancy and having an adrenal mass with suspicious imaging characteristics. Although adrenal metastases are frequently bilateral and greater than 3 cm in size, they may be unilateral and small. A fine-needle biopsy of an adrenal mass may be indicated for diagnosis in such cases. Adrenal carcinoma presenting as an incidental adrenal mass is exceedingly rare. Metastatic tumors in people with no known malignancy is considerably more common. The following report illustrates 1 such case in a 57-year-old man with no prior malignancy, presenting with hemoptysis due to a cavitary lesion in his right lung. A large, right adrenal mass with suspicious imaging characteristics was incidentally noted. Fine-needle biopsy of the adrenal mass proved to squamous cell carcinoma, most likely of the lung. This is a rare case of lung carcinoma (hitherto unknown) presenting with an adrenal mass, where final diagnosis was made by adrenal biopsy.