GIANT ADRENOCORTICAL CARCINOMA RESSECTION WITH ENLARGED MERCEDESBENZ INCISION: A CASE REPORT

Malignant neoplasm of adrenal cortex corresponds to 0.05 to 2% of all malignancies. Among the possible histopathological diagnoses, the most common are adrenocortical adenoma (52% of cases), adrenocortical carcinoma (12%) and pheochromocytoma (11%). Adrenocortical carcinoma is a rare neoplasm with incidence ranging from 0.7 to 2 cases / million inhabitants / year, which predominates in females. We report a case of giant adrenocortical carcinoma, which was resected using Mercedes-Benz enlarged incision. A 43-year-old female patient attended an oncology service with a history of abdominal distension, lower limb pain and vomiting in the 7 months prior to the consultation, with a weight loss of 31 kg. Denies alcoholism and smoking. Patient postmenopausal, with a grandmother with history of uterine cancer, using atenolol 25 mg. On physical examination, palpable mass in the left upper and lower quadrants of the abdomen, as well as bilateral 1+ / 4 + lower limb edema and 3 + / 4 + petechiae. Chest computed tomography (CT) without abnormalities and abdomen showing splenomegaly and volumous expansive formation in the left renal store, with apparent topography of the upper pole of the left kidney (or in close contact with it), measuring about 22.7×20.5×20.1 cm in its larger diameters, moving the remaining portions of the left kidney inferiorly, the pancreas superiorly and the aorta to the right. Electrocardiogram (ECG) with no abnormalities and there was no significant increase in tumor markers. The patient was admitted for exploratory laparotomy in order to resect a possible pheochromocytoma of the left adrenal gland, with enlarged MercedesBenz incision. Left total nephrectomy was performed with left adrenalectomy and splenectomy. The anatomopathological report of the piece found a congested spleen free of neoplasia and poorly differentiated neoplasia, widely necrotic and with diffuse dystrophic calcifications, affecting the adrenal and left kidney, measuring 30×25 cm. Ascitic fluid collected during surgical procedure was negative for malignancy. Immunohistochemical analysis of the specimen showed positivity for the markers synaptophysine, calretinin and alpha-inhibin, concluding that it was an adrenocortical carcinoma infiltrating renal parenchyma. We consider the description of this case important because of the low incidence of this type of tumor and the large size of it, as well as the surgical technique used to improve the exposure of the surgical field.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019