by Chutima Paiboon, MD1
1Department of Radiology, UbonRatchathaniCancerHospital
Abstract Adrenocortical carcinoma (ACC) is a rare malignancy. It can be divided into two major subtypes; functioning and non-functioning tumor depending on the capability of hormone production. Patients with functioning tumors may present clinical symptoms related to hormone overproduction such as Cushing’s syndrome, which is the result of overproduction of cortisol. On the other hand, patients with non-functioning tumor usually present symptoms related to mass effect from the tumor such as abdominal discomfort, palpable abdominal mass, or be suffering from dyspepsia, which was found to be the case for the patient in this report.
We report a case of a 61-year-old Thai male who had been complaining of worsening dyspepsia for 2 months. Abdominal ultrasound showed a large left suprarenal mass. CT scan of the chest and upper abdomen showed a 9-cm heterogeneous enhancing mass at the left adrenal gland. There were multiple liver metastases and metastatic osteolytic lesions involving the spine, rib and iliac bone. Apart from this, thrombus in IVC and left renal vein and pulmonary embolism were also identified. He underwent left adrenalectomy and liver biopsy. The histopathological results revealed adrenocortical carcinoma and liver metastases. He was subsequently treated with systemic chemotherapy and palliative radiation at the lumbar spine.
This report presents the spectrum of clinical manifestation of the patient with non-functioning ACC which can present with nonspecific dyspepsia secondary to underlying growing abdominal tumor. They potentially have metastases at an initial presentation, which carry a poor prognosis.
Keywords: adrenocortical carcinoma, adrenal mass, diagnosis