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Case Reports
. 2021 Jul 16;9(20):5575-5587.
doi: 10.12998/wjcc.v9.i20.5575.

Giant androgen-producing adrenocortical carcinoma with atrial flutter: A case report and review of the literature

Mircea-Florin Costache  1 , Raluca-Elena Arhirii  2 , Simona-Juliette Mogos  3 , Corina Lupascu-Ursulescu  4 , Cezara-Ioana Litcanu  5 , Adi-Ionut Ciumanghel  6 , Catalina Cucu  7 , Cristina-Mihaela Ghiciuc  8 , Antoniu-Octavian Petris  9 , Nicolae Danila  1
Affiliations
Case Reports

Giant androgen-producing adrenocortical carcinoma with atrial flutter: A case report and review of the literature

Mircea-Florin Costache et al. World J Clin Cases. .

Abstract

Background: Adrenocortical carcinoma (ACC), the second most aggressive malignant tumor, lacks epidemiological data worldwide; therefore, every new case can improve the understanding of the pathology and treatment of this malignancy.

Case summary: We present the case of a 66-year-old Caucasian woman with a giant androgen-producing ACC (21 cm × 17 cm × 12 cm; 2100 g), without metastases, which unusually presented with an acute onset of atrial flutter and congestive heart failure. The cardiac complications observed in our case support the hypothesis that androgen excess in women is a cardiovascular risk factor. Androgen excess in women can be a rare cause of reversible dilated cardiomyopathy, therefore a comprehensive approach to the patient is essential to improve the recognition of androgen-secreting ACC. The atrial flutter was remitted after initiation of drug treatment during admission. The severe heart failure was totally remitted at 6 mo after radical open surgery to remove the giant ACC.

Conclusion: Radical open surgery to remove a giant androgen-producing ACC was the first-line treatment to cure the excess of androgen, which determined the total remission of cardiac complications at 6 mo after surgery in the women of this case report.

Keywords: Adrenalectomy; Adrenocortical carcinoma; Androgen secreting tumor; Atrial flutter; Case report; Heart failure.

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Conflict of interest statement

Conflict-of-interest statement: Authors declare no conflict of interests for this article.

Figures

Figure 1
Figure 1
Large left side abdominal mass.
Figure 2
Figure 2
Twelve-lead electrocardiogram. A: On admission: Typical atrial flutter and 2:1 atrioventricular conduction with left bundle branch block; B: Preoperative: Sinus rhythm with left bundle branch block.
Figure 3
Figure 3
Abdominal computed tomography–arterial acquisition, maximum intensity projection reformatted planes. A: Coronal view showing a well-defined heterogeneously enhancing mass in the left adrenal gland, with central calcifications and non-enhancing necrotic areas, with arterial blood supplied from the aorta and left renal artery, and upward displacement of the stomach; B: Sagittal view showing a well-defined heterogeneous mass in the left upper quadrant displacing the left kidney; C: Oblique view displaying the relationship of the lesion with the left renal arterial pedicle.
Figure 4
Figure 4
Pseudocapsulated tumor. A: Macroscopic view of en bloc specimen of an encapsulated mass with smooth contours, with no evidence of invasion, weighing 2100 g, with dimensions of 21 cm × 17 cm × 12 cm; B: Final aspect after removing the tumor; C and E: Macroscopic view of the resected tumor; D: Detailed view of tumor measurements.
Figure 5
Figure 5
Adrenocortical carcinoma. A: Large solitary circumscribed tumor with a variegated appearance on the cut surface due to hemorrhage and necrosis; B: Diffuse architecture of the tumor and capsular invasion (hematoxylin & eosin, × 25); C: Intense positivity for Melan A in tumor cells (immunohistochemistry, × 25); D: Intense positivity for synaptophysin (immunohistochemistry, × 200).
Figure 6
Figure 6
Case history timeline. CT: Computed tomography; DHEAS: Dehydroepiandrosterone sulfate; ECG: Electrocardiogram; INR: International normalized ratio.
See this image and copyright information in PMC

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