A 62-year-old man has a 5.2-cm adrenal incidentaloma with irregular borders and 28 HU on CT. Hormonal workup is normal. PET-CT is FDG-avid. What is the best management?
Answer: C
Explanation: Size >4 cm + irregular margins + HU >20 + FDG-avid ? high risk of carcinoma, requiring open adrenalectomy.
Teaching Points: Biopsy is contraindicated unless pheochromocytoma is excluded and metastasis suspected.