Late local relapse of adrenocortical carcinoma 18 years after adrenalectomy: case report
ARTICLE PDF (Українська)

Keywords

adrenocortical cancer, local relapse, disease-free surveillance, nephrectomy

How to Cite

Tkachenko, R. P., Kuryk, O. G., Golovko, A. S., & Lazarenko, G. O. (2018). Late local relapse of adrenocortical carcinoma 18 years after adrenalectomy: case report. Clinical and Preventive Medicine, (2-3), 116-122. https://doi.org/10.31612/2616-4868.2-5.2018.13

Abstract

Adrenocortical carcinoma (ACC) is a rare neoplasm, that occurs in 0,5-2 cases per million people.They are more likely to take place by women (59% cases). In 50% cases tumor cells release one of adrenocortical gland hormones, what makes for special manifestations of this pathology including virilism and clinical symptoms of hyperadrenalismus. In most cases adrenocortical carcinomas are exceeding 20 cm in diameter and have a strong tendency to invade the adrenal vein, vena cava. The median survival is about 2 years.

Case presentation. A 35-year-old woman was admitted to the hospital with 2-months history of abdominal and flank pain, headache, resistant to medical therapy hypertencion crisis (up to 220/130 mmHg). She had a remarkable medical history: a left adrenalectomy was executed for an adrenocortical carcinoma 18 years ago. Pathohistological conclusion (1998) – low differentiated left adrenocortical carcinoma. The final clinical diagnosis: рT3NxМо, ІІІ stage, 3 clinical group. The patient underwent prophylactic follow-up every 3 months including urine steroid examination, abdominal CT, etc. Results of medical investigations (abdominal CT with intravenosus contrast, thorax CT, mammography, laboratory analysis, US) while admission to hospital (November 2016) resulted in clinical diagnosis: retroperitoneal extraorganic lest-sided neoplasm. Recurrence of adrenal cortical carcinoma. The operation was performed: left-sided nephrectomy, left-sided adrenalectomy. A tumor sized 7×6×5 cm was excised. Pathohistological conclusion: low differentiated adrenocortical carcinoma, with necrosos areas, vena renalis invasion.

            Discusion. ACC is a rare and highly aggressive malignancy accounting for an estimated of all 0.02% of cancers. Moreover, there are only 20 cases reported in the literature and to the best of our knowledge there have been no cases about surveillance more than 5 years. Regarding the appearance of adrenal masses on the left side, we initially did a diagnostic workup to exclude metastasis from extra-adrenal organs but avoided the adrenal biopsy according to the recent guidelines.

https://doi.org/10.31612/2616-4868.2-5.2018.13
ARTICLE PDF (Українська)

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