A CASE OF HUGE NON-FUNCTIONAL ADRENAL CORTICAL CARCINOMA

Abstract

This paper presents a case of huge non-functional adrenal cortical carcinoma.
A 29-year-old man with a 10-month history of general fatigue was referred to the hospital after an increase in white blood cell (WBC) count was pointed out at a medical checkup. On physical examination, an infant's head sized and elastic hard tumor with tenderness was palpated in the left upper abdomen. The WBC count was as high as 16100/mm³. Abdominal CT scan revealed an enhanced tumor 20 cm in diameter with calcification which had heterogeneous center. Magnetic resonance imaging scan visualized concomitant presence of low and high intensities on both T1- and T2-weighted images. Abdominal angiogram showed accumulation of contrast material from the left superior, middle, and inferior adrenal arteries. Adrenal hormone levels were in normal ranges. With a diagnosis of a non-functional adrenal cortical tumor, the left adrenal tumor was removed with associated resection of the left kidney, spleen, and pancreatic body and tail with periaortic lymph node dissection. The resected specimen showed a tumor 24×16×10 cm in dimension with a capsule and an extensively necrotic inner part. The histopathological diagnosis was adrenal cortical carcinoma.