Adrenal carcinoma.

Adrenal cortical carcinoma is an uncommon but highly malignant tumor. Functioning tumors are detected earlier than nonfunctioning neoplasms such that patients with functioning tumors are younger and the tumors smaller than in patients with nonfunctioning tumors. Most tumors are quite large by presentation and are easily detected by imaging studies. CT is the primary imaging modality and can be used to stage most patients accurately. MR may be employed to clarify equivocal findings, especially the delineation of venous extension. Surgery is the only effective treatment, so precise tumor delineation is essential. Chemotherapy with ortho para DDD provides some palliation, but the prognosis remains poor.