Adrenocortical neoplasm in a 2-year-old child - Clinical approach and diagnostic imaging

Sep 21, 2026

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Adrenocortical tumors in children and adolescents are rare and aggressive, making clinical recognition essential, especially when most cases relate to Li-Fraumeni syndrome. Virilization from androgen excess is the most typical presentation. Imaging is central to diagnosis and management: CT and MRI help differentiate benign from malignant adrenal lesions, characterize tumor features, and define local extent and possible metastases. Correlating imaging with clinical presentation and histopathology supports accurate risk assessment and treatment planning. The report describes a healthy 2-year-old boy presenting with virilization and diagnosed with adrenocortical carcinoma.

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Case Report

Abstract

Case presentations

Imaging and diagnostic findings

Radiology Ca s e Reports 19 (2024) 6417 – 6422 Available online [at](at www.sciencedirect.com)[ www.sciencedirect.com](at www.sciencedirect.com) journal [homepage:](homepage: www.elsevier.com/locate/radcr)[ www.elsevier.com/locate/radcr](homepage: www.elsevier.com/locate/radcr) | Case Report
Adrenocortical neoplasm in a 2-year-old child:
Clinical approach and diagnostic imaging✩,✩✩
Nathalia Sofia Coral-Riveraa,∗, Alejandra Vinascob, Andrés Hernando Tascon-Baronac
a Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia b Facultad de ciencias de la salud, Universidad Icesi, Cali, Colombia
c Departamento de Radiología e Imágenes Diagnósticas, Fundación Valle del Lili, Cali, Colombia | | | | --- | --- | --- | | a r t i c l e i n f o | | a b s t r a c t | | Article history:
Received 9 September 2024 Accepted 21 September 2024 | | Adrenocortical tumors in children and adolescents are rare and aggressive, accounting for only 0.2% of pediatric cancers, with most cases associated with Li-Fraumeni syndrome. The most common manifestation is virilization due to androgen excess. Imaging techniques are crucial in the diagnosis and management of pediatric adrenocortical carcinoma. CT and MRI are essential for differentiating between benign and malignant lesions and assessing tumor characteristics and extent. Correlating imaging findings with clinical and histopathological data is vital for optimal diagnosis and treatment, underscoring the need for a multidisciplinary approach to managing these rare but aggressive neoplasms. This report presents the case of a previously healthy 2-year-old boy who exhibited virilization symptoms and was diagnosed with adrenocortical carcinoma.
© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
This is an open access article under the CC BY-NC-ND license
([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) | | Keywords:
Adrenocortical neoplasms Adrenocortical carcinoma Children
Adrenal gland
Magnetic resonance imaging | | | common manifestation is typically virilization due to excess androgens, with or without the presence of other adrenal hormones [4] . Accurate visualization of the tumor and potential metastases is crucial, making computed tomography (CT) and magnetic resonance imaging (MRI) effective tools for the differential diagnosis of adrenal masses. Although these methods alone cannot accurately determine the nature of the tumor, a comprehensive clinical approach, informed by an understanding of the clinical manifestations and pathophysiology of adrenal tumors, can help differentiate between high-risk and low-risk neoplastic lesions [2] . ✩ Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ✩✩ Present address: Fundación Valle del Lili, Av. Simón Bolívar-Carrera 98 \# 18-49, Cali, Colombia. ∗ Corresponding author. E-mail [address:](address: nathalia.coral.ri@fvl.org.co)[ nathalia.coral.ri@fvl.org.co](address: nathalia.coral.ri@fvl.org.co) (N.S. Coral-Rivera). [https://doi.org/10.1016/j.radcr.2024.09.116](https://doi.org/10.1016/j.radcr.2024.09.116) 1930-0433/© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) Fig. 1 – A: A mass (blue arrow) replaces the left adrenal gland. It has an oval shape with well-defined borders, exerts a compressive effect on adjacent structures, and loses the separation plane with the upper pole of the left kidney due to infiltration (B: red arrow). The signal intensity is heterogeneous, predominantly hyperintense on T2 (relative to the liver) with cystic foci. The periph

FAQs

What is the most common clinical manifestation of pediatric adrenocortical tumors?

Virilization due to androgen excess is the most common manifestation. It may occur with or without other adrenal hormone involvement.

Why are CT and MRI important in this condition?

CT and MRI are crucial to visualize the tumor and potential metastases, differentiate benign from malignant adrenal lesions, and evaluate tumor characteristics and extent.

How was the 2-year-old patient diagnosed in the case report?

A contrast-enhanced abdominal MRI identified a large left adrenal neoplasm highly suggestive of carcinoma, with invasion, tumor thrombus, and lymphadenopathy. A chest CT subsequently showed bilateral metastatic pulmonary nodules and findings consistent with pulmonary thromboembolism.

Sep 21, 2026

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