Abstract
Adrenocortical tumors are rare neoplasms with poor prognosis and with an incidence of one in one million population. They are categorized as either functional (hormone-secreting) or silent and as either benign or malignant. We are reporting a very rare case of huge (16 cm) adrenocortical carcinoma in a 19-years-old male patient who presented with a progressively increasing right abdominal mass and uncontrolled systemic blood pressure for 2 years. Clinical exam was unremarkable for syndromic features. There was no history of precocious puberty. Imaging studies confirm the presence of a large right adrenal mass with malignant features. Laboratory tests including the hormonal work up were unremarkable. Endocrinology team was involved in the perioperative management of the patient followed by a complete surgical excision of the tumor. Patient tolerated the procedure and discharged in good condition. Follow up appointments confirm the stabilization of the blood pressure and general condition with no evidence of recurrence at 1-year post-resection.
Highlights
Adrenocortical carcinomas (ACCs) are rare; the incidence is approximately one to two per million population per year as described by Ng L and Libertino JM [1]
The clinical manifestations related to tumor growth maybe the main presenting issues in most patients with nonfunctioning tumors, or with an incidentally found adrenal mass detected on radiographic imaging
Dehner LP, Hill DA suggest that children with ACC have a better prognosis than do adults; favorable clinical outcome has been reported in 70% or more of pediatric cases [7]
Summary
Adrenocortical carcinomas (ACCs) are rare; the incidence is approximately one to two per million population per year as described by Ng L and Libertino JM [1]. Social history included smoking and social drinking He presented to a local Emergency Department with elevated blood pressure. Imaging showed a large right adrenal mass measuring 16 by 11 cm detected through CT and MRI of the abdomen (Figure 1a and Figure 1b). There was no evidence of gross invasion to the surrounding structure nor were there any obvious metastatic lesions It was completely excised en-bloc with the right adrenal gland and the surrounding Gerota’s fascia as well as the locoregional lymph nodes including the renal Hilary lymph nodes. Figures 1: Axial and coronal sections of MRI abdomen showed the hetrogenous mass in the right adrenal gland. MRI abdomen (Figure 1a and Figure 1b) showed a large right suprarenal mass measuring 16 × 8 × 11 cm. Giving the unusual presentation of this case, the histopathological diagnosis was confirmed at 2 different institutions
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