Table 2.
Results of the literature review including 10 case reports of initially benign AIs transformed to ACCs
| Ref | Age, Sex(F/M) | Initial symptom, lateralisation | Initial size | Initial CT/MRI features | Initial hormonal profile | Last CT/MRI before ACC diagnosis: time/size | ACC characteristics on imaging (CT/MRI) | Time to progression from initial diagnosis | Final size, increase per year | Hormonal hypersecretion on FU | Histology |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Parry et al 2024 (5) | 70 y F | Flushing, right AI | 8 mm | 3 HU (noncontrast)/ND | NF | 2y/8 mm ACA (stable for 6 y) | 32 HU noncontrast (washout = 0%) | 7 y | 66 × 49 mm, 29 mm/y | NF | ACC, Weiss:5, Ki-67:20%, (stage II) |
| Ohkubo et al 2024 (6) | 50 y, F | Fever, right AI | 20 × 20 mm | 32 HU (noncontrast), delayed washout/lipid-rich | Hyperaldosteronism | ND | Enlarged size | 1 y | 130 mm, 110 mm/y | Cortisol and aldosterone | ACC, Weiss:7, Ki-67:36% |
| Kohli et al 2021 (7) | 70 y, F | No relevant symptoms, left AI | 20 × 16 mm | >10 HU (noncontrast) with 67% absolute washout and 47% relative wash out/ND |
NF | 1y/20 × 16 mm ACA (stable for 7 y) | 37 HU noncontrast, 98 HU postcontrast |
8 y | 58 × 43 mm, 38 mm/y | Cortisol | ACC, Ki-67:30%, (stage II) |
| Aono et al 2022 (12) | 77 y, F | No relevant symptoms, left AI | 15 × 16 × 15 mm | 30 HU, homogeneous, rounded/ND | NF | 1y/21 × 28 × 30 mm ACA (stable for 6 y) | Heterogenous with cystic degeneration/No signal loss in the out of phase | 9 y | 35 × 41 × 54 m, 14 mm/y | Cortisol | ACC, Weiss:4, Ki-67:20%, CTNNB1, G34A mutation |
| Gagnon et al 2020 (13) | 32 y, F | Non specific abdominal pain, left AI | 29 × 19 mm | 31 HU/isointense in T2 with few hyperintense areas, no loss of signal in the out of phase | NF | 6y/29 × 19 mm ACA (stable for 5 y) | Two new hepatic lesions | 10 y | 90 × 82 mm, 10 mm/y | Cortisol and androgens | ACC, Ki-67:30%, APC mutation |
| Rebielak et al 2019 (8) | 28 y, F | Left flank pain, left AI | 27 × 21 mm | In favor of ACA/ND | Elevated total/free testosterone | 7y/27 × 21 mm ACA (stable for 7 y) | 25% absolute washout/47 × 59 mm enhanced left adrenal mass | 7 y | 56 × 37 × 40 mm, 4 mm/y | Testosterone | ACC, Ki-67:30%, (stage II) |
| Barsukova et al 2019 (11) | 72 y, F | ND, left AI | −2007: 15 mm -2016: 37 mm -2018: 68mm |
−2007: In favor of ACA/ND -2016: 15 HU with 42% relative washout/ND -2018: ND/large lobulated heterogeneous mass |
2007:NF 2016: hypercortisolaemia 2018: recurrence of hypercortisolaemia (adrenalectomy) |
2 y (post-adrenalectomy) | Heterogeneous with new nodules superior and posterior to kidney | −NF to cortisol-secreting ACA: 9 y - Recurrence postsurgery: 2 y |
68 × 41 × 59 mm, 34 mm/y | Cortisol | −1st surgery Weiss:2 (ACA) -2nd surgery: ACC |
| Thuzar et al 2018 (9) | 47 y, F | No relevant symptoms, left AI | 13mm | In favor of ACA/ND | NF | 10 m/20 × 15 × 17mm | Large heterogenous atypical mass | 3 y | 100 × 90 × 130 mm, 80 mm/y | NF | ACC, Weiss:5, Ki-67:40%, (stage II) |
| Belmihoub et al 2017 (10) | 71 y, M | Urinary tract infection, right AI | 17 mm | In favor of ACA/ND | NF | 5y/21 mm (9 HU) | 5 HU noncontrast, < 50% absolute washout/No signal loss in the out-of-phase | 8 y | 60 mm, 8 mm/y | Cortisol | ACC, Weiss:8, Ki-67:30% (stage II) |
Abbreviations: ACA, adrenocortical adenoma; ACC, adrenocortical carcinoma; AI, adrenal incidentaloma; CT, computerized tomography; F, female; FU, follow-up; HU, Hounsfield units; M, male; MRI, magnetic resonance imaging; ND, no data; NF, nonfunctioning; y, years.