Adrenal tuberculosis mimicking a malignancy by direct hepatic invasion: emphasis on adrenohepatic fusion as the potential route


      A 64-year-old female with primary adrenal insufficiency presented with a right adrenal mass showing quantitative nonadenoma features on dedicated adrenal computed tomography (CT). CT showed direct invasion of the mass to the adjacent hepatic parenchyma, and high uptake was noted on 18F-fluorodeoxyglucose positron emission tomography/CT. Laparoscopy revealed gross invasion of the adrenal lesion into the liver, which led to the en bloc resection including the involved liver. Polymerase chain reaction analysis of the surgical specimen revealed adrenal tuberculosis.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Yang ZG
        • Guo YK
        • Li Y
        • Min PQ
        • Yu JQ
        • Ma ES
        Differentiation between tuberculosis and primary tumors in the adrenal gland: evaluation with contrast-enhanced CT.
        Eur Radiol. 2006; 16: 2031-2036
        • Lattin GE
        • Sturgill ED
        • Tujo CA
        • Marko J
        • Sanchez-Maldonado KW
        • Craig WD
        • et al.
        From the radiologic pathology archives: adrenal tumors and tumor-like conditions in the adult: radiologic–pathologic correlation.
        Radiographics. 2014; 34: 805-829
        • Zhang XC
        • Yang ZG
        • Li Y
        • Min PQ
        • Guo YK
        • Deng YP
        • et al.
        Addison's disease due to adrenal tuberculosis: MRI features.
        Abdom Imaging. 2008; 33: 689-694
        • Lam KY
        • Lo CY
        A critical examination of adrenal tuberculosis and a 28-year autopsy experience of active tuberculosis.
        Clin Endocrinol (Oxf). 2001; 54: 633-639
        • Ohwada S
        • Izumi M
        • Kawate S
        • Hamada K
        • Toya H
        • Togo N
        • et al.
        Surgical outcome of stage III and IV adrenocortical carcinoma.
        Jpn J Clin Oncol. 2007; 37: 108-113
        • Honma K
        Adreno-hepatic fusion. An autopsy study.
        Zentralbl Pathol. 1991; 137: 117-122
        • Okano K
        • Usuki H
        • Maeta H
        Adrenal metastasis from hepatocellular carcinoma through an adrenohepatic fusion.
        J Clin Gastroenterol. 2004; 38: 912
        • Woo HS
        • Lee KH
        • Park SY
        • Han HS
        • Yoon CJ
        • Kim YH
        Adrenal cortical adenoma in adrenohepatic fusion tissue: a mimic of malignant hepatic tumor at CT.
        AJR Am J Roentgenol. 2007; 188: W246-W248
        • Park BK
        • Kim CK
        • Jung BC
        • Suh YL
        Cortical adenoma in adrenohepatic fusion tissue: clue to making a correct diagnosis at preoperative computed tomography examination.
        Eur Urol. 2009; 56: 1082-1085
        • Jeong YJ
        • Lee KS
        Pulmonary tuberculosis: up-to-date imaging and management.
        AJR Am J Roentgenol. 2008; 191: 834-844
        • Wang X
        • Shi X
        • Yi C
        • Chen Z
        • Zhang B
        • Zhang X
        Hepatic tuberculosis mimics metastasis revealed by 18F-FDG PET/CT.
        Clin Nucl Med. 2014; 39: e325-e327
        • Ramia JM
        • Muffak K
        • Fernandez A
        • Villar J
        • Garrote D
        • Ferron JA
        Gallbladder tuberculosis: false-positive PET diagnosis of gallbladder cancer.
        World J Gastroenterol. 2006; 12: 6559-6560
        • Park SY
        • Park BK
        • Kim CK
        The value of adding (18)F-FDG PET/CT to adrenal protocol CT for characterizing adrenal metastasis (>/= 10 mm) in oncologic patients.
        AJR Am J Roentgenol. 2014; 202: W153-W160
        • Wang L
        • Yang J
        Tuberculous Addison's disease mimics malignancy in FDG-PET images.
        Intern Med. 2008; 47: 1755-1756
        • Li YJ
        • Cai L
        • Sun HR
        • Gao S
        • Bai RJ
        Increased FDG uptake in bilateral adrenal tuberculosis appearing like malignancy.
        Clin Nucl Med. 2008; 33: 191-192
        • Ng L
        • Libertino JM
        Adrenocortical carcinoma: diagnosis, evaluation and treatment.
        J Urol. 2003; 169: 5-11
        • Lam KY
        • Lo CY
        Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital.
        Clin Endocrinol (Oxf). 2002; 56: 95-101
        • Redman BG
        • Pazdur R
        • Zingas AP
        • Loredo R
        Prospective evaluation of adrenal insufficiency in patients with adrenal metastasis.
        Cancer. 1987; 60: 103-107