Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Apr 3;16(6):1329-1334.
doi: 10.1016/j.radcr.2021.03.006. eCollection 2021 Jun.

Non-functioning adrenocortical carcinoma

Bui-Van Lenh  1   2 , Nguyen Minh Duc  2   3   4 , Thieu-Thi Tra My  2 , Tran Ngoc Minh  5 , Luong Viet Bang  6 , Le Tuan Linh  1   2 , Bui-Van Giang  2 , Pham Minh Thong  2
Affiliations
Case Reports

Non-functioning adrenocortical carcinoma

Bui-Van Lenh et al. Radiol Case Rep. .

Abstract

Adrenocortical carcinoma (ACC) is a rare malignancy that arises from the adrenal cortex and can be classified as either non-functioning or functioning. A patient with non-functioning ACC may present no specific symptoms. Imaging analysis can provide some information to a clinician who suspects ACC, such as tumor size, density, washout, necrosis, hemorrhage, and calcification. Histopathology is used to confirm and determine the origin of the malignancy and can provide relevant prognostic information. Microscopic findings can be used to obtain information such as the Weiss score, resection surface features, Ki-67 proliferative index, and the degree of capsular and vascular invasion. Surgery can be curative for localized tumors, and adjuvant therapy using mitotane and cytotoxic chemotherapy is often employed for advanced-stage tumors. We describe a case report of a 32-year-old man with a non-functioning ACC that highlights the importance of radiological and pathological features in the diagnosis of ACC and their use as prognostic factors.

Keywords: Adrenal tumor; Adrenocortical carcinoma; Rare neoplasm.

PubMed Disclaimer

Figures

Fig 1 –
Fig. 1
Axial computed tomography (CT) scan, pre-contrast. The left adrenal mass was heterogeneous, with a low-density of −18 HU and a high density of 60 HU (arrows).
Fig 2 –
Fig. 2
Axial (A and B) and coronal reconstruction (C and D) CT scans in the arterial phase. The mass was hypervascular (A, arrowheads), with heterogeneous enhancement (B, arrow). The mass compressed the left kidney (C, arrow) and the left renal vein, resulting in the dilatation of the left gonadal vein (D, arrowheads).
Fig 3 –
Fig. 3
Axial CT scan in the venous phase. The mass was heterogeneous, with an elevated level of enhancement in the venous phase (arrows).
Fig 4 –
Fig. 4
The cut surface revealed a heterogeneous mass with a white to red appearance. Areas of hemorrhage and adipose tissue were identified.
Fig 5 –
Fig. 5
Hematoxylin and eosin (HE) staining. The tumor had a fibrous capsule, without evidence of capsular or vascular invasion (A, × 40), and a necrotic region (B, × 40). The patterns that are typical of adrenal cortical adenomas were replaced by a diffuse trabecular pattern, characterized as nuclear grades III and IV. Greater than 20 mitotic figures/50 HPFs were observed (C, × 100). Atypical mitotic figures were identified (D, × 400).
Fig 6 –
Fig. 6
Positive immunohistochemistry results (× 200) for calretinin (A) and synaptophysin (B).
Fig 7 –
Fig. 7
Negative immunohistochemistry results for (× 200) (A) chromogranin, (B) Melan A, and (C) S100. (D) The Ki67 index was > 5%.
See this image and copyright information in PMC

References

    1. Kostiainen I., Hakaste L., Kejo P., Parviainen H., Laine T., Löyttyniemi E. Adrenocortical carcinoma: presentation and outcome of a contemporary patient series. Endocrine. 2019;65(1):166–174. - PMC - PubMed
    1. Kerkhofs T.M.A., Verhoeven R.H.A., Van der Zwan J.M., Dieleman J., Kerstens M.N., Links T.P. Adrenocortical carcinoma: a population-based study on incidence and survival in the Netherlands since 1993. Eur J Cancer. 2013;49(11):2579–2586. - PubMed
    1. Stigliano A., Chiodini I., Giordano R., Faggiano A., Canu L., Della Casa S. Management of adrenocortical carcinoma: a consensus statement of the Italian Society of Endocrinology (SIE) J Endocrinol Invest. 2016;39(1):103–121. - PubMed
    1. Lucon A.M., Pereira M.A., Mendonça B.B., Zerbini M.C., Saldanha L.B., Arap S. Adrenocortical tumors: results of treatment and study of Weiss's score as a prognostic factor. Rev Hosp Clínicas. 2002;57(6):251–256. - PubMed
    1. Bharwani N., Rockall A.G., Sahdev A., Gueorguiev M., Drake W., Grossman A.B. Adrenocortical carcinoma: the range of appearances on CT and MRI. Am J Roentgenol. 2011;196(6):W706–W714. - PubMed

Publication types

LinkOut - more resources