Introduction: Adrenocortical carcinoma is a rare and highly aggressive cancer, with an incidence of about 0.5 cases per million people each year.It often presents at advanced stages and could show few or none symptoms.This case report describes the diagnosis, surgical treatment, and prognosis of a large non functional adrenocortical carcinoma in a 70 year old, female.Methods: A 70 years old, female, presented with fatigue, weakness and 10 kg weight loss over the past month.Her medical history included uncontrolled hypertension.On physical examination, the abdomen has a palpable mass on the left side.Laboratory test results showed hyperglycemia (259mg/dl) and leukocytosis.Abdominal ultrasound and contrast CT scan revealed a 6 cm left adrenal mass extending toward the posterior gastric wall, without invasion of the kidney, pancreas or spleen.Results: The gross pathology showed an encapsulated mass weighing 385 grams, measuring 10.5 x 9.5 x 6.5 cm with 30% necrosis.Histological analysis confirmed high grade oncocytic adrenocortical carcinoma, Fuhrman nuclear grade IV, with capsular and periadrenal fat invasion, 28 mitoses per 50 high power fields, and lymphovascular invasion.Surgical margins were 100% free of tumor.The patient had an uneventful postoperative recovery and was discharged on day 10 with normal laboratory results and stable vitals signs.She was referred for outpatient oncologic follow up.Conclusion: This case highlights the importance of early identification and multidisciplinary surgical planning for adrenal tumors.Complete resection with negative margins is essential for good prognosis, especially in highrisk histological subtypes.Although rare, oncocytic adrenocarcortical carcinoma non fictional should be considered in elderly patients with retroperitoneal masses.Long term follow up is crucial due to the high risk of recurrence related to vascular invasion and necrosis.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.
Ogura et al. (Wed,) studied this question.