BRAIN METASTASIS IN PATIENTS WITH ADRENOCORTICAL CARCINOMA IS MORE COMMON THAN PREVIOUSLY REPORTED

Brain Metastasis in Patients with Adrenocortical Carcinoma is more common than previously reported Introduction: Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. Metastatic ACC has a dismal prognosis with overall survival of less than one year. The most common sites of metastasis are lung, liver, lymph nodes, and less commonly, the bones. Central nervous system (CNS) metastasis is a rare and late event with an estimated incidence of 1-2%, and just a few cases have been reported in the medical literature. Objective: To describe the clinical characteristics of patients with ACC treated at Instituto do Câncer do Estado de São Paulo (ICESP) who developed brain metastasis. Methods: Medical charts were retrospectively reviewed to identify ACC patients with confirmed brain metastasis. Clinical characteristics and pathologic data were collected, and a literature review was performed. Results: Between 2010 and 2019, 54 patients were treated for ACC at ICESP. Six cases with CNS metastasis were identified (11,1%). The median age at the time of diagnosis of ACC was 44 years (range 24-61 mo). The median time between diagnosis of ACC and presentation of brain metastasis was 20.8 months (range 5-53 mo). All six patients had been previously treated with mitotane and four of them with at least one line of cytotoxic therapy. At the time of brain metastasis, systemic diseases were detected in all cases in at least four sites. All patients presented with a single brain lesion. Bleeding was the symptom of presentation in all but one diagnosed without symptoms during CNS screening. Four of six patients presented with CNS recurrence during the follow-up. The median time between CNS metastasis and death was 3.8 months (range 0.4-59.6 mo). In four of six patients, brain metastasis was the leading cause of death. Conclusions: In our series, brain metastasis was more common than previously reported. Additionally, brain metastasis was associated with substantial morbidity and was the leading cause of death in most of the affected patients.

Publication History

Article published online:
23 October 2019