Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014, 158(3):474-478 | DOI: 10.5507/bp.2013.040

Giant adrenocortical carcinoma with 27-month disease-free survival by surgical resection alone: A case report

Martin Strakaa, Renata Soumarovab, Jan Bulejcikc, Martin Banikd, Mikulas Purae, Matej Skrovinaa
a Department of Surgery, Comprehensive Cancer Centre, Hospital Novy Jicin, Novy Jicin, Czech Republic
b Department of Oncology and Radiotherapy, Comprehensive Cancer Centre, Hospital Novy Jicin, Novy Jicin
c Department of Vascular and Minimally Invasive Surgery, Hospital Podlesi, Trinec
d Department of Pathology, Comprehensive Cancer Centre, Hospital Novy Jicin, Novy Jicin
e Department of Endocrinology, National Institute of Endocrinology and Diabetology, Lubochna, Slovakia

Background: Adrenocortical cancer (ACC) is a rare disease with an estimated incidence of 1-2/million/year. The tumour stage and completeness of surgical resection have the biggest impact on survival. Whereas stage I-II patients survive in 55-64% of cases, only 0-5% of patients with stage IV disease are still alive at 5 years. A median survival of 33 months can be expected after curative surgery. Incomplete surgery leads to a significant drop in survival.

Method: We present a 40-year-old man who underwent a technically demanding complete surgical excision of a giant (26 cm, 2372 g) ACC and experienced a 27-month disease-free survival without any systemic treatment. Detailed description of the surgical anatomy in relation to tumour size and patient body constitution is provided. The surgical strategy and exposure pitfalls under such extreme circumstances are discussed.

Conclusion: To achieve R0 resection in locally advanced disease, en bloc resection with neighbouring organs is widely recommended. Giant tumours may however pose a technical challenge due to space constraints.

Keywords: adrenocortical carcinoma, adrenal tumour, surgical resection, disease-free survival

Received: January 21, 2013; Accepted: May 21, 2013; Prepublished online: June 18, 2013; Published: September 30, 2014  Show citation

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Straka, M., Soumarova, R., Bulejcik, J., Banik, M., Pura, M., & Skrovina, M. (2014). Giant adrenocortical carcinoma with 27-month disease-free survival by surgical resection alone: A case report. Biomedical papers, 158(3), 474-478. doi: 10.5507/bp.2013.040
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    References

    1. Reibetanz J, Kroiss M, Deutschbein T, Fenske W, Gasser M, Jurowich C, Germer CT, Allolio B, Fassnacht M. [German adrenocortical carcinoma registry. Surgical therapy results and follow-up treatment.][Article in German] Chirurg 2012;83:528-35. Go to original source... Go to PubMed...
    2. National Cancer Institute PDQ.General Information About Adrenocortical Carcinoma [online]. 2012 Nov [cited 2012 Nov 24].Available from:http://www.cancer.gov/cancertopics/pdq/treatment/adrenocortical/HealthProfessional
    3. Allolio B, Fassnacht M. Clinical review: adrenocortical carcinoma: clinical update. J Clin Endocrinol Metab 2006;91:2027-37. Go to original source... Go to PubMed...
    4. Pura M. [Adrenocortical cancer]. In: Pacák K, Lazúrová I, editors. [Endocrinetumors of adrenal gland in currentclinical practice]. Praha: Galén; 2011. p. 174-99. [Article in Slovak]
    5. Bertagna X, Groussin L, Abiven G, Bertherat J. Adrenal cortical carcinoma: clinical management. In: Bertagna X, editor. Adrenal cancer.Montrouge: Éditions John Libbey Eurotext; 2006. p. 1-12.
    6. Schulick RD, Brennan MF. Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol 1999;6:719-26. Go to original source... Go to PubMed...
    7. Lombardi CP, Raffaelli M, Boniardi M, De Toma G, Marzano LA, Miccoli P, Minni F, Morino M, Pelizzo MR, Pietrabissa A, Renda A, Valeri A, De Crea C, Bellantone R.Adrenocortical carcinoma: effect of hospital volume on patient outcome. Langenbecks Arch Surg 2012;397:201-7. Go to original source... Go to PubMed...
    8. Lughezzani G, Sun M, Perrote P, Jeldres C, Alasker A, Isbabarn H, Budäus L, Shariat SF, Guazzoni G, Montorsi F, Karakiewicz PI. The European Network for the Study of Adrenal Tumors is prognostically superior to the international union against cancer-staging system: A North American validation. Eur J Cancer 2010;46:713-9. Go to original source... Go to PubMed...
    9. Fassnacht M, Allolio B. Clinical management og adrenocortical carcinoma. Best Pract Res Clin Endocrinol Metab 2009;23:273-89. Go to original source... Go to PubMed...
    10. Dousset B, Gaujoux S, Thillois JM. Surgical treatment of adrenal cortical carcinoma. In: Bertagna X, editor. Adrenal cancer. Montrouge: Éditions John Libbey Eurotext; 2006. p. 71-95.
    11. Harrison LE, Gaudin PB, Brennan MF. Pathologic features of prognostic significance for adrenal cortical carcinoma after curative resection. Arch Surg 1999;134:181-5. Go to original source... Go to PubMed...
    12. Icard P, Goudet P, Charpenay C, Andreassian B, Carnaille B, Chapuis Y, Cougard P, Henry JF, Proye C.Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group. World J Surg 2001;25:891-7. Go to original source... Go to PubMed...
    13. Vassilopoulou-Sellin R, Schultz PN. Adrenal cortical carcinoma. Clinical outcome at the end of the 20th century. Cancer 2001;92:113-21. Go to original source...
    14. Pommier RF, Brennan MF. An eleven-year experience with adrenocortical carcinoma. Surgery 1992;112:963-71. Go to PubMed...
    15. Stojadinovic A, Ghossein RA, Hoos A, Nissan A, Marshall D, Dudas M, Cordon-Cardo C, Jaques DP, Brennan MF. Adrenocortical carcinoma: clinical morphologic, and molecular characterization. J Clin Oncol 2002;20:941-50. Go to original source... Go to PubMed...
    16. Assié G, Guillaud-Bataille M, Ragazzon B, Bertagna X, Bertherat J, Clauser E. The pathophysiology, diagnosis and prognosis of adrenocortical tumors revisited by transcriptome analyses.Trends Endocrinol Metab2010;21:325-34. Go to original source... Go to PubMed...
    17. Morimoto R, Satoh F, Murakami O, Suzuki T, Abe T, Tanemoto M, Abe M, Uruno A, Ishidoya S, Arai Y, Takahashi K, Sasano H, Ito S.Immunohistochemistry of a proliferation marker Ki67/MIB1 in adrenocortical carcinomas: Ki67/MIB1 labeling index is a predictor for recurrence of adrenocortical carcinomas. Endocr J 2008;55:49-55. Go to original source... Go to PubMed...
    18. Ohwada S, Izumi M, Tanahashi Y, Susumu Kawate, Hamada K, Tsutsumi H, Horiguchi J, Koibuchi Y, Takahashi T, YamadaM. Combined liver and inferior vena cava resection for adrenocortical carcinoma. Surg Today 2007;37:291-7. Go to original source... Go to PubMed...
    19. Gaujoux S, Al-Ahmadie H, Allen PJ, Gonen M, Shia J, D'Angelica M, Dematteo R, Fong Y, Blumgart L, Jarnagin WR. Resection of adrenocortical carcinoma liver metastasis: is it justified? Ann Surg Oncol 2012;19:2643-51. Go to original source... Go to PubMed...
    20. Fassnacht M, Terzolo M, Allolio B, Baudin E, Haak H, Berruti A, Welin S, Schade-Brittinger C, Lacroix A, Jarzab B, Sorbye H, Torpy DJ, Stepan V, Schteingart DE, Arlt W, Kroiss M, Leboulleux S, Sperone P, Sundin A, Hermsen I, Hahner S, Willenberg HS, Tabarin A, Quinkler M, de la Fouchardière C, Schlumberger M, Mantero F, Weismann D, Beuschlein F, Gelderblom H, Wilmink H, SenderM, Edgerly M, Kenn W, Fojo T, Müller HH, Skogseid B;FIRM-ACT Study Group. Combination chemotherapy in advanced adrenocortical carcinoma. N Engl J Med 2012; 366:2189-97. Go to original source... Go to PubMed...
    21. Milgom SA, Goodman KA. The role of radiation therapy in the management of adrenal carcinoma and adrenal metastases. J Surg Oncol 2012;106:647-50. Go to original source... Go to PubMed...

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