Abstract
Adrenocortical carcinoma (ACC) is a rare malignancy with an overall unfavorable prognosis. Clinicians treating patients with ACC have noted accelerated growth in metastatic liver lesions that requires rapid intervention compared to other metastatic locations. This study measured and compared the growth rates of metastatic ACC lesions in the lungs, liver, and lymph nodes using volumetric segmentation. A total of 12 patients with metastatic ACC (six male; six female) were selected based on their medical history. Computer tomography (CT) exams were retrospectively reviewed and a sampling of ≤5 metastatic lesions per organ were selected for evaluation. Lesions in the liver, lung, and lymph nodes were measured and evaluated by volumetric segmentation. Statistical analyses were performed to compare the volumetric growth rates of the lesions in each organ system. In this cohort, 5/12 had liver lesions, 7/12 had lung lesions, and 5/12 had lymph node lesions. A total of 92 lesions were evaluated and segmented for lesion volumetry. The volume doubling time per organ system was 27 days in the liver, 90 days in the lungs, and 95 days in the lymph nodes. In this series of 12 patients with metastatic ACC, liver lesions showed a faster growth rate than lung or lymph node lesions.
Highlights
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with an estimated incidence of 1.5–2 per million people per year
Metastatic lesions found in locations other than the lung, liver, or lymph nodes were excluded from analysis due to small sample size
As the care of each individual patient can vary depending on case specifics and the location of their metastatic burden, the data collected from this cohort may alert clinicians to the importance of actively monitoring metastatic ACC liver lesions closely for signs of rapid growth compared to other organ systems
Summary
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with an estimated incidence of 1.5–2 per million people per year. It has a very poor prognosis with an overall. Complete open resection of the primary tumor with negative surgical margins confers the best prognosis, local recurrence and/or metastatic disease is still common even in this scenario [3]. ACC most commonly metastasizes to the lung (40–80%), liver (40–90%), and bone (5–20%), and resection of metastatic lesions can improve 5-year survival, reduce pain, and control hormone production [2,3,4,5,6]. Prospective and retrospective studies indicate that mitotane monotherapy or combined therapy of mitotane with cytotoxic drugs such as etoposide, doxorubicin, and cisplatin may increase progression-free and recurrence-free survival in patients with adrenocortical cancer [11,12]
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