Nonfunctioning adrenal cortical carcinoma with skeletal muscle metastasis: Case report and imaging at limited resource center

Adrenal cortical carcinoma (ACC) is a rare, aggressive endocrine malignancy with a reported incidence of 1.0-2.0 cases per million population and a poor prognosis due to metastatic spread. About 25% of cases of ACC present with metastases at the time of diagnosis. Metastatic spread of ACC commonly involves lungs, liver, kidney, peritoneum, lymph nodes, venous extension to the renal vein or inferior vena cava and bone. We report a case of a 47-year-old male with a nonfunctioning ACC with metastases to skeletal muscle (subscapularis, paraspinal, iliacus and gluteus maximus muscle) in addition to metastasis to the lung, which was not reported in the literature. Unfortunately, the patient expired prior to the surgery due to respiratory distress.