Giant Adrenocortical Carcinoma: A Case Report and Review of the Relevant Literature

Patient: Female, 63-year-old Final Diagnosis: Adrenal cortical carcinoma Symptoms: Abdominal pain and discomfort Medication: — Clinical Procedure: Excision of the recurrent mass along with the tail of the pancreas and a small part of the left lobe of the liver • extended open surgical excision of the mass with an esophago-jejunal anastomosis and a side to side jejuno-jejunal anastomosis Specialty: Endocrinology and Metabolic • Oncology • Surgery OBJECTIVE: Rare disease 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 7(th) 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.