A rare case of synchronous adrenocortical carcinoma and renal cell carcinoma

Abstract

We present here a rare case of synchronous adrenocortical carcinoma (ACC) and renal cell carcinoma (RCC). A 27-year-old woman presented with gradual abdominal distension, hematuria, and loss of weight of 3-months duration. She gave a history of treatment for hypertension. The computed axial tomography (CT) scan revealed a large retroperitoneal mass. Her urinary VMA was slightly elevated. Her 24-h urinary metanephrine level was normal. The patient underwent left adrenalectomy, left nephrectomy, spleenectomy, and distal pancreactomy with segmental colonic resection. Postoperative pathology revealed ACC of left suprarenal measuring 22 × 19 × 18 cm3 and RCC involving the left upper pole of kidney measuring 3 × 2 × 1 cm3.

First Case Report of a Sporadic Adrenocortical Carcinoma With Gastric Metastasis and a Synchronous Gastrointestinal Stromal Tumor of the Stomach

“…Only 14 cases with synchronous or metachronous tumors associated with sporadic ACC were reported to date, this being the 15th; the clinicopathological data of these cases are shown in Table 1 . 2 , 3 , 7 – 17 No GIST-associated ACCs have been reported before; only one 3-cm-sized right adrenal adenoma was incidentally found at ultrasound examination in a 48-year-old man with a gastric GIST. 18 ACC can also be developed as part of the following inherited familial cancer syndromes: Li-Fraumeni syndrome, familial Becwith–Wiedemann syndrome, Gardner syndrome, and multiple endocrine neoplasia type 1.…”

“…Tumor invasion was also noticed in the sinusoid capillaries; large veins with huge tumor emboli and intravascular platelet conglutination were also present. The tumor displayed 9 of the 9 Weiss's criteria 3 for malignancy: expanded areas of necrosis, capsular/vascular and sinusoidal invasion, high mitotic count, abundant atypical mitoses, high nuclear grade, diffuse architecture, and few vacuolar cells.…”

Synchronous ipsilateral adrenocortical carcinoma and renal cell carcinoma: a rare clinical entity

“…Rarely, synchronous RCC and ACC may coexistent together 2. The clinical presentation of ACC and RCC varies, ranging from vague abdominal pain to full blown hormonal syndromes when ACC becomes biochemically active.…”

Adrenocortical carcinoma: An extremely uncommon entity and the role of Immunohistochemistry in its diagnosis

“…It is therefore, necessary to make a systematic approach to inspect renal parenchyma in serial sections, and extensions. [3]…”

“…On the other hand, renal cell carcinoma (RCC) also frequently involves the adrenal gland. [13] Naturally, it is very difficult clinically and radiologically, and at times histologically, to differentiate between ACC and RCC. It is also difficult to differentiate ACC from lesions such as adrenal medullary neoplasms, adrenal adenoma, and secondaries to adrenals even in histological sections rendering immunohistochemistry essential.…”