Multidisciplinary team therapy for left giant adrenocortical carcinoma: A case report

Figure 1 Computerized tomography scan after admission. A: Computer three-dimensional reconstruction (the arrow indicates a retroperitoneal mass); B: Uneven heterogeneous enhancement in the arterial phase.

Figure 2 Postoperative pathological results: The tumor cells showed alveolar, solid, trabecular and other growth modes, and the tumor cells showed clear nucleoli and atypia. Some areas of mitotic phase > 20/50 high-power field showed focal necrosis and partial mucinous degeneration. Tumor thrombus could be seen in the vessel. The mass size was 20 cm × 10 cm × 7 cm and was consistent with adrenocortical carcinoma. No renal invasion was observed. Tumor thrombus was observed in the renal vein. Immunohistochemical results revealed the following: S100(-), HMB-45(-), Melan-A (weakly positive), Inhibin-α (weakly positive), CgA(-), CKpan (local focus+), Vimentin(+), Syn(+), TFE3 (nucleus individual+), PAX-8(-), P53 (20% nucleus+), CD34(+), and Ki-67 (15%).

Figure 3 The 20 cm × 10 cm × 7 cm adrenal mass (A and B).

Figure 4 Multiple retroperitoneal lymph node metastases increased (the arrow on the left indicates hepatic metastases, the arrow on the right indicates spleen metastases). A: After the peritoneum was visible in the operative area, a nodular soft tissue density shadow with a size of approximately 15 mm × 19 mm could be seen. Multiple patchy slightly low-density shadows could be seen scattered in the liver parenchyma with fuzzy boundaries (the arrow indicates a nodular soft tissue density shadow in the retroperitoneal area); B: Local recurrence and invasion of the spleen were observed, with near-elliptical low-density foci of approximately 17 mm × 24 mm in the leading edge of the spleen. The number of multiple metastases in the liver increased.