Giant androgen-producing adrenocortical carcinoma with atrial flutter: A case report and review of the literature

Figure 1 Large left side abdominal mass.

Figure 2 Twelve-lead electrocardiogram. A: On admission: Typical atrial flutter and 2:1 atrioventricular conduction with left bundle branch block; B: Preoperative: Sinus rhythm with left bundle branch block.

Figure 3 Abdominal computed tomography–arterial acquisition, maximum intensity projection reformatted planes. A: Coronal view showing a well-defined heterogeneously enhancing mass in the left adrenal gland, with central calcifications and non-enhancing necrotic areas, with arterial blood supplied from the aorta and left renal artery, and upward displacement of the stomach; B: Sagittal view showing a well-defined heterogeneous mass in the left upper quadrant displacing the left kidney; C: Oblique view displaying the relationship of the lesion with the left renal arterial pedicle.

Figure 4 Pseudocapsulated tumor. A: Macroscopic view of en bloc specimen of an encapsulated mass with smooth contours, with no evidence of invasion, weighing 2100 g, with dimensions of 21 cm × 17 cm × 12 cm; B: Final aspect after removing the tumor; C and E: Macroscopic view of the resected tumor; D: Detailed view of tumor measurements.

Figure 5 Adrenocortical carcinoma. A: Large solitary circumscribed tumor with a variegated appearance on the cut surface due to hemorrhage and necrosis; B: Diffuse architecture of the tumor and capsular invasion (hematoxylin & eosin, × 25); C: Intense positivity for Melan A in tumor cells (immunohistochemistry, × 25); D: Intense positivity for synaptophysin (immunohistochemistry, × 200).

Figure 6 Case history timeline. CT: Computed tomography; DHEAS: Dehydroepiandrosterone sulfate; ECG: Electrocardiogram; INR: International normalized ratio.