Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2021; 9(20): 5737-5743
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5737
Multidisciplinary team therapy for left giant adrenocortical carcinoma: A case report
Zheng Zhou, Hong-Mei Luo, Jian Tang, Wu-Jun Xu, Bin-Hui Wang, Xu-Hui Peng, Heng Tan, Li Liu, Xiang-Yang Long, Yu-De Hong, Xiao-Bin Wu, Jian-Ping Wang, Bai-Qi Wang, Hai-Hui Xie, Yong Fang, Yong Luo, Rong Li, Yi Wang
Zheng Zhou, Jian Tang, Wu-Jun Xu, Bin-Hui Wang, Xu-Hui Peng, Heng Tan, Li Liu, Xiang-Yang Long, Yu-De Hong, Xiao-Bin Wu, Yi Wang, Department of Urology, The Second Affiliated Hospital, University of South China, Hengyang 421001, Hunan Province, China
Hong-Mei Luo, Department of Histology and Embryology, Clinical Anatomy and Reproductive Medicine Application Institute, University of South China, Hengyang 421001, Hunan Province, China
Jian-Ping Wang, Department of Endocrinology, The Second Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
Bai-Qi Wang, Department of Oncology, The Second Affiliated Hospital, University of South China, Hengyang 421001, Hunan Province, China
Hai-Hui Xie, Department of Radiotherapy , The Second Affiliated Hospital, University of South China, Hengyang 421001, Hunan Province, China
Yong Fang, Department of Pathology, The Second Affiliated Hospital , University of South China, Hengyang 421001, Hunan Province, China
Yong Luo, Department of ICU, The Second Affiliated Hospital, University of South China, Hengyang 421001, Hunan Province, China
Rong Li, Department of Clinical Pharmacy, The Second Affiliated Hospital, University of South China, Hengyang 421001, Hunan Province, China
Author contributions: Zhou Z wrote the manuscript; Tang J, Wang BH, Peng XH, and Tan H collected the case data and prepared the photos; Wang Y, Long XY, Xu WJ, Liu L, Hong YD, and Wu XB participated in the operation; Wang JP, Wang BQ, Xie HH, Fang Y, Luo Y, and Li R participated in the discussion and treatment; Luo HM and Wang Y proofread and revised the manuscript; All authors have read and approved the final manuscript.
Supported by Foundation of Hunan Educational Committee, No. 16A188; Foundation of Hengyang Science and Technology Committee, No. 2018KJ135.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi Wang, PhD, Chief Physician, Department of Urology, The Second Affiliated Hospital, University of South China, No. 35 Jiefang Avenue, Zhengxiang District, Hengyang 421001, Hunan Province, China. wangwang0906@163.com
Received: March 16, 2021
Peer-review started: March 16, 2021
First decision: April 24, 2021
Revised: May 6, 2021
Accepted: May 24, 2021
Article in press: May 24, 2021
Published online: July 16, 2021
Processing time: 113 Days and 3.7 Hours
Abstract
BACKGROUND

Adrenocortical carcinoma (ACC) is a rare malignant epithelial tumor originating from adrenocortical cells that carries a very poor prognosis. Metastatic or inoperable diseases are often considered incurable, and treatment remains a challenge. Especially for advanced cases such as ACC complicated with renal venous cancer thrombus, there are few cumulative cases in the literature.

CASE SUMMARY

The patient in this case was a 39-year-old middle-aged male who was admitted to the hospital for more than half a month due to dizziness and chest tightness. Computed tomography (CT) findings after admission revealed a left retroperitoneal malignant space-occupying lesion, but the origin of the formation of the left renal vein cancer thrombus remained to be determined. It was speculated that it originated from the left adrenal gland, perhaps a retroperitoneal source, and left adrenal mass + left nephrectomy + left renal vein tumor thrombus removal + angioplasty were performed under general anesthesia. Postoperative pathology results indicated a diagnosis of ACC. Postoperative steroid therapy was administered. At 3 mo after surgery, abdominal CT reexamination revealed multiple enlarged retroperitoneal lymph nodes and multiple low-density shadows in the liver, and palliative radiotherapy and mitotane were administered, considering the possibility of metastasis. The patient is currently being followed up.

CONCLUSION

ACC is a highly malignant tumor. Even if the tumor is removed surgically, there is still the possibility of recurrence. Postoperative mitotane and adjuvant chemoradiotherapy have certain benefits for patients, but they cannot fully offset the poor prognosis of this disease.

Keywords: Adrenocortical carcinoma; Ki-67; Multidisciplinary team; Cancer thrombus; Mitotane; Case report

Core Tip: Adrenocortical carcinoma (ACC) is a highly malignant tumor that is rarely seen in the clinic, especially with renal venous cancer thromboembolism, and the prognosis is very poor. In metastatic or locally advanced cases of ACC, there are a limited number of available treatments, and the curative effect is not significant. Priority is often given to surgical tumor reduction treatment, with mitotane as the basis of treatment. If the condition deteriorates, cytotoxic drugs should be added and radiotherapy taken into consideration.