Feminizing Adrenocortical Carcinoma with Distant Metastases: Can Surgery be Considered?

Abstract

Functioning adrenocortical carcinomas are rare diseases with dismal prognosis. A 41-year-old man presenting with gynecomastia had a giant feminizing adrenocortical carcinoma at stage IV. Although surgical resection was controversial, we removed the primary tumor to reduce the mass effects. He lived for 12 months with an acceptable quality of life. Gynecomastia may be the first sign of feminizing adrenal malignancies. Surgery may ameliorate the quality of life in selected patients with metastatic disease.

Keywords: Adrenocortical carcinoma; feminizing; gynecomastia; rare tumor; treatment.

Figure 1.

Computed tomographic scan of the abdomen revealed a large tumor of the left adrenal (25 cm in its maximum diameter) with colliquative areas, occupying almost entirely the hemiabdomen.

Figure 2.

The adrenal mass measured 25×17 cm, and appeared encapsulated, yellowish with extensive areas of necrosis and mucoid degeneration, encompassing the left kidney (black arrow).

Figure 3.

Histological examination with standard hematoxylin and eosin showing a proliferation of large epithelial cells and pleomorphic oxyphil nuclei (A, 200×; B, 400×), with large areas of necrosis and endovascular embolization (C, 100×; D, 200×). Immunohistochemistry showing strong positivity for Melan-A and Synaptophysin in the tumor cells (E, 200×; F, 200×).