Adrenocortical cancer recurrence following initial transcutaneous biopsy: a rare demonstration of needle tract seeding

Abstract

Summary: Needle tract seeding is a potential, albeit rare, complication following transcutaneous biopsies, leading to the seeding of tumor cells along the path of the needle. Biopsies of adrenal masses are not routinely recommended and are only indicated, after exclusion of pheochromocytoma, when an adrenal metastasis of a primary extra-adrenal cancer is suspected or when pathological confirmation of inoperable adrenocortical cancer (ACC) may impact treatment. Despite guideline recommendations to avoid primary adrenal biopsy, very few needle tract seeding cases have been reported and none were in the context of an ACC. We report the occurrence of needle tract seeding in a patient following adrenal transcutaneous biopsy leading to ACC abdominal wall recurrence.

Learning points: Needle tract seeding is a rare complication of transcutaneous biopsy. It may increase morbidity and impact overall survival. It has yet to be documented in adrenocortical carcinoma (ACC).Adrenal masses can be accurately evaluated for malignancy using a combination of conventional and metabolic imaging, such as CT and fluorodeoxyglucose-PET, obviating the need for biopsies.Adrenal mass biopsy is not indicated in ACC unless advanced ACC is diagnosed, and a pathological confirmation would impact management.

Keywords: adrenocortical carcinoma; metastasis; needle biopsy.

Figure 1

(A) A 15 cm, heterogenous, retroperitoneal mass is shown on coronal (left panel) and axial (right panel) abdominal CT imaging with i.v. contrast. (B) The first abdominal wall recurrence, 2 years following initial surgery: a 3 cm mass is seen in the left anterior abdominal wall on CT (arrow). (C) Second recurrence, 3 years after surgery. (C1) A 2.1 × 1.3 cm left anterior abdominal wall lesion is seen respectively on CT (upper panel) and FDG-PET (lower panel) (arrow). (C2) A 2.2 × 1.5 cm retroperitoneal recurrence is shown, on the superior pole of the left kidney, behind the splenic vein at the initial tumor bed, respectively on MRI (left panel) and FDG-PET (right panel) (arrow).

Figure 2

(A) Obvious vascular invasion at the periphery of the primary cortico-adrenal tumor. (B) Higher power showing marked nuclear pleomorphism and mitotic activity in primary tumor. (C and D) Recurrent tumor nodules invading the abdominal wall, showing similar morphology with the primary tumor.

Figure 3

Axial (A) and coronal (B) CT imaging of radiation therapy planning targeting the anterior abdominal wall recurrence (A) and the retroperitoneal mass at the initial tumor bed (B).