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Mantzoros I, Bitsianis S, Loutzidou L, Ntampakis G, Chatzakis C, Christidis P, Gkiouliava A, Koraki E, Aggelopoulos S. Giant Adrenocortical Carcinoma: A Case Report and Review of the Relevant Literature. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928875. [PMID: 33813589 PMCID: PMC8033218 DOI: 10.12659/ajcr.928875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/24/2021] [Accepted: 02/02/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Adrenocortical carcinomas are rare and aggressive tumors often diagnosed as incidentalomas. The malignancy can present with abnormal hormone secretion or the tumor may be non-functioning and present as a palpable mass causing discomfort. Here, we present a case of an adrenal cortical carcinoma originally identified as an incidentaloma. CASE REPORT A 63-year-old woman presented with abdominal pain and discomfort. A large abdominal mass, occupying the left upper and lower quadrant, was palpated. Imaging revealed a mass occupying the left abdomen between the stomach and the spleen, applying pressure on the pylorus, duodenum, splenic vessels, and pancreas. The mass size was 21.2×13×14.6 cm. Hormonal investigations were normal. Surgical exploration was performed, and the tumor was excised. Pathological analysis revealed an adrenocortical carcinoma and the patient underwent adjuvant chemotherapy. Twelve months later, the carcinoma recurred. The patient underwent a second operation in which the recurrent mass was excised along with the tail of the pancreas and a small part of the left lobe of the liver. The postoperative period was uneventful, and the patient was discharged home on the 7th postoperative day. No further adjuvant therapy was applied. The patient remains disease-free 18 months after the reoperation. CONCLUSIONS Giant adrenocortical carcinomas, although rare, pose a challenge to the surgical team both diagnostically and therapeutically. Surgical excision with the appropriate oncologic support can guarantee excellent outcomes.
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Affiliation(s)
- Ioannis Mantzoros
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Stefanos Bitsianis
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Lydia Loutzidou
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Georgios Ntampakis
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Christos Chatzakis
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Panagiotis Christidis
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Anna Gkiouliava
- Department of Anesthesiology, General Hospital of Thessaloniki “G. Papanikolaou”, Exochi, Thessaloniki, Greece
| | - Eleni Koraki
- Department of Anesthesiology, General Hospital of Thessaloniki “G. Papanikolaou”, Exochi, Thessaloniki, Greece
| | - Stamatios Aggelopoulos
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
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Sinclair TJ, Gillis A, Alobuia WM, Wild H, Kebebew E. Surgery for adrenocortical carcinoma: When and how? Best Pract Res Clin Endocrinol Metab 2020; 34:101408. [PMID: 32265101 DOI: 10.1016/j.beem.2020.101408] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Adrenocortical carcinoma (ACC) is a rare malignancy that is frequently asymptomatic at presentation, yet has a high rate of metastatic disease at the time of diagnosis. Prognosis is overall poor, particularly with cortisol-producing tumors. While the treatment of ACC is guided by stage of disease, complete surgical resection is the most important step in the management of patients with primary, recurrent, or metastatic ACC. Triphasic chest, abdomen, and pelvis computer tomography (CT) scans and 18F flourodeoxyglucose positron emission tomography CT scanning are essential for accurate staging; moreover, MRI may be helpful to identify liver metastasis and evaluate the involvement of adjacent organs for operative planning. Surgical resection with negative margins is the single most important prognostic factor for survival in patients with ACC. To achieve the highest rate of R0 resection, open adrenalectomy is the gold standard surgical approach for confirmed or highly suspected ACC. It is extremely important that the tumor capsule is not ruptured, regardless of the surgical approach used. The best post-operative outcomes (complications and oncologic) are achieved by high-volume surgeons practicing at high-volume centers.
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Affiliation(s)
- Tiffany J Sinclair
- Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrea Gillis
- Division of General Surgery, Department of Surgery, Albany Medical College, Albany, NY, USA
| | - Wilson M Alobuia
- Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Hannah Wild
- Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Electron Kebebew
- Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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