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Exp Clin Endocrinol Diabetes 2012; 120(08): 472-476
DOI: 10.1055/s-0032-1321807
Article
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Peritoneal Carcinosis in Apparently Benign Cortisol Producing Adrenal Adenoma≥5 cm in Diameter: The Need of Regular Postoperative Surveillance

Authors

  • M. Brauckhoff

    1   Department of Surgery, Haukeland University Hospital, Bergen, Norway
    2   Department of Surgical Sciences, University of Bergen, Bergen, Norway
    3   Department of General, Visceral, and Vascular Surgery, University Hospital Halle, Halle, Germany

  • J. E. Varhaug

    1   Department of Surgery, Haukeland University Hospital, Bergen, Norway
    2   Department of Surgical Sciences, University of Bergen, Bergen, Norway

  • S. Hauptmann

    4   Department of Pathology, University Hospital Halle, Halle, Germany

  • L. A. Akslen

    5   Gades Institute, University of Bergen, Bergen, Norway
    6   Department of Pathology, Haukeland University Hospital, Bergen, Norway

  • P. N. Thanh

    3   Department of General, Visceral, and Vascular Surgery, University Hospital Halle, Halle, Germany

  • A. Viste

    1   Department of Surgery, Haukeland University Hospital, Bergen, Norway
    2   Department of Surgical Sciences, University of Bergen, Bergen, Norway

  • A. Heie

    1   Department of Surgery, Haukeland University Hospital, Bergen, Norway

  • H. Dralle

    3   Department of General, Visceral, and Vascular Surgery, University Hospital Halle, Halle, Germany
Further Information

Publication History

received 15 March 2012
first decision 06 June 2012

accepted 28 June 2012

Publication Date:
31 July 2012 (online)

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Abstract

Background:

Clinical and histopathological distinction between benign and malignant adrenocortical tumors can be a challenge.

Methods:

Report on 2 patients with cortisol producing apparently benign adrenal adenomas≥5 cm in diameter with local malignant recurrence and peritoneal carcinomatosis after endoscopic surgery.

Results:

Case 1: The 59-year-old male presented with adrenal hypercortisolism due to a 5.0 cm large adrenal tumor on the left side. A retroperitoneoscopic total adrenalectomy was performed. Histologically, a benign adrenal adenoma (Weiss score 1, Ki-67<2%) was found. 6 months later, the patient developed clinically and biochemically recurrent disease with recurrent tumor in the left adrenal region and peritoneal carcinomatosis. The patient died 5 months after second surgery.

Case 2: The 32-year-old female was pregnant in 27th week when presenting with adrenal hypercortisolism due to a 5.5 cm large adrenal tumor on the left side. She was operated on using a laparoscopic approach and a total adrenalectomy was carried out. Histological examination revealed a benign adrenocortical adenoma (Weiss score 1, Ki-67<5%). 4 years later, the patient came back with clinically and biochemically recurrent disease. Imaging showed a 10 cm large tumor in the left retroperitoneum and a diffuse peritoneal carcinomatosis. The patient died 2 months after diagnosis.

Conclusion:

Cortisol producing adrenal tumors≥5 cm in diameter are at risk to be misdiagnosed as apparently benign. Regular surveillance should be considered in patients presenting with large cortisol producing tumors.

Key words

adrenal cushing disease - malignant recurrence - postoperative surveillance