Giant adrenocortical carcinoma simulating a liver tumor

Aïcha Ben Miled,Ramzi Nouira,Wejih Dougaz,Chadli Dziri,Mohamed Ali,Hichem Jerraya,Ibtissem Bouasker

doi:10.31487/j.aco.2019.01.02

Abstract

Adrenocortical carcinoma is a rare malignant tumor which can reach large sizes if it is nonfunctioning. In that situation, it can pose diagnosis dilemmas regarding the origin and the nature of the tumor. We reported a case of non-secreting and large right Adrenocortical carcinoma which arose in the posterior costophrenic angle mimicking a liver tumor. A 45-year-old man presented with a voluminous abdominal mass in the right upper quadrant. The different imaging modalities including ultrasound computed tomography and magnetic resonance imaging were discordant as regards the hepatic or the adrenal origin of the tumor. Percutaneous biopsy allowed to determine the diagnosis of the cortico-adrenal tumor. The patient underwent laparotomy. The tumor which arose from the right adrenal gland was resected. Pathology confirmed the diagnosis of adrenocortical carcinoma with histological factors of poor prognosis. The patient was given Mitotane as adjuvant therapy. After six years of follow-up, a tumor recurrence has been diagnosed.

Highlights

Adrenocortical carcinoma (ACC) is a rare but aggressive tumor [1]
We reported a case of right ACC which presented a diagnostic challenge with a liver tumor due to its non-secreting status and its large size
ACC is a rare, aggressive tumor arising from the adrenal cortex that typically presents late in the form of a large mass [3] with an average size of around 13 cm [4]

Summary

Introduction

Adrenocortical carcinoma (ACC) is a rare but aggressive tumor [1]. Its diagnosis relies in most of the cases on hormonal workup and imaging [1]. In the case of a nonfunctioning and large tumor, the diagnosis of ACC may be difficult and other non-adrenal pathologic conditions may be discussed [2]. We reported a case of non-secreting and large right ACC which arose in the posterior costophrenic angle mimicking a liver tumor

Case report

Discussion