Disseminated adrenocortical carcinoma: case report

Adrenocortical carcinoma is a rare neoplasm occurring with a frequency of 1–2 cases per million. It is characterized by significant malignancy with the mean survival of about 28 months, and in the presence of documented metastases survival is shorter up to 8 months. This type of a tumor is slightly more frequent in women (58.6%) than in men (41.4%). Etiology of adrenocortical carcinoma is still unclear, but a role of genetic and environmental factors has been largely considered. Most of the carcinomas (60%) are functional and usually the first manifestation is Cushing’s syndrome with virilization. The tumor size is still the best single predictor of prognosis. Histopathology specimen from biopsy or obtained during operation should be stained for Melan A, which can confirm the adrenal origin of the tumor. The only method of treatment is a complete surgical excision of the carcinoma. However, because of its dynamics, metastases cannot be reliably excluded. We present the case of functioning adrenocortical cancer in a 37-year-old patient who at the time of diagnosis had 12 cm in diameter tumor of the left adrenal gland and metastases to the liver and lung. In the article the symptoms associated with hormones produced by the carcinoma, diagnostics and treatment with regard to the progression of the disease have also been discussed.