A 5-year 11-month-old girl had a rapidly enlarging and tender right upper-quadrant mass. She was a thin, cheerful child in no apparent distress. The mass extended 10 cm below the right costal margin and 2 cm across the midline. There were no clinical or laboratory signs of hormonal abnormality. Plain films of the abdomen were obtained (Fig 1), and intravenous (IV) urography was performed (Fig 2).
Denouement and Discussion
Nonhormonal Adrenocortical Carcinoma
A suprarenal mass can displace the kidney and occasionally may distort its intrarenal urographie appearance. Marked compression and deformity of the kidney as seen on this patient's urogram suggest an intrarenal mass, but dense calcification (Fig 1) is unusual in Wilms' tumor1 and other intrarenal masses in children. Of adrenal tumors, calcification is most common in neuroblastoma but can be seen with adenoma, carcinoma, or dermoid tumors.2 Adrenal calcification also occurs idiopathically, following adrenal hemorrhage, and in tuberculosis,