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Review
. 2021 Apr 30:12:677187.
doi: 10.3389/fendo.2021.677187. eCollection 2021.

Case Report: Complete Necrosis of a Large Adrenocortical Cancer and Liver Metastases Achieved by Selective Arterial Embolization: A Case Study and Review of Literature

Gergely Huszty  1 , Attila Doros  1 , Katalin Farkas  1 , László Kóbori  1 , Péter Reismann  2   3 , Judit Tőke  2   3 , Miklós Tóth  2   3 , Peter Igaz  2   3   4
Affiliations
Review

Case Report: Complete Necrosis of a Large Adrenocortical Cancer and Liver Metastases Achieved by Selective Arterial Embolization: A Case Study and Review of Literature

Gergely Huszty et al. Front Endocrinol (Lausanne). .

Abstract

There is very limited experience regarding the interventional radiological treatment of adrenocortical cancer (ACC). We present the case of a 57-year-old female patient with a large, potentially unresectable left-sided ACC and two hepatic metastases. Both liver tumors were effectively treated by trans-arterial embolization (TAE), followed by TAE of the bulky primary tumor as a life-saving intervention necessitated by severe intratumoral bleeding. Surgical removal of the primary tumor revealed complete necrosis. The patient is considered tumor free after 3.5 years. To the best of our knowledge, this is the first report to show that even a primary ACC may be completely ablated by selective embolization, and the fourth to prove the curative potential of liver TAE for ACC metastases. This case highlights the potential of selective embolization in ACC treatment.

Keywords: adrenocortical cancer; embolization; liver metastasis; necrosis; trans-arterial.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
CT scan of 20 cm large left adrenocortical carcinoma (*) with segment 8 liver metastasis (†). The segment 7 tumor is not shown on this reconstruction (A). Necrosis on CT after liver TAE (††) and embolization of the previously bleeding primary tumor (**) (B). Abscess from the necrotic tumor reaching the thigh (+) (C). Drains in the abscess (arrows); the descending part is already resolved (D, E).
Figure 2
Figure 2
Timeline of case.
Figure 3
Figure 3
Embolization of the S8 tumor through the right replaced hepatic artery was achieved with 0.1mm PVA particles (A). Embolization of the primary tumor through the left inferior phrenic artery was performed by 0.2mm PVA particles (B). CT, celiac trunk; SA, splenic artery; CHA, common hepatic artery; GDA, gastroduodenal artery; *, dominant suprarenal artery from left inferior phrenic artery.
Figure 4
Figure 4
Surgical removal of the necrotic primary tumor together with the left kidney after resolution of the descending abscess. The left renal vein is clamped.
See this image and copyright information in PMC

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