An Adrenocortical Carcinoma Evolving from A Small Adrenal Incidentaloma after Years of Latency
ABSTRACT: Objective: Adrenal incidentalomas (AIs) are frequent clinical problems. Although most are benign and nonsecretory, the possibility of malignancy is a concern. We report here a case of adrenocortical carcinoma (ACC) evolving from a small AI, 3 years after initial detection.Methods: We repor...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-01-01
|
| Series: | AACE Clinical Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060520304569 |
| _version_ | 1818409999950413824 |
|---|---|
| author | Moe Thuzar, MBBS, MRCP (UK), FRACP Donald A. Perry-Keene, MBBS, FRACP Michael C. d'Emden, MBBS, FRACP, PhD Emma L. Duncan, MBBS, FRACP, FRCP, PhD |
| author_facet | Moe Thuzar, MBBS, MRCP (UK), FRACP Donald A. Perry-Keene, MBBS, FRACP Michael C. d'Emden, MBBS, FRACP, PhD Emma L. Duncan, MBBS, FRACP, FRCP, PhD |
| author_sort | Moe Thuzar, MBBS, MRCP (UK), FRACP |
| collection | DOAJ |
| description | ABSTRACT: Objective: Adrenal incidentalomas (AIs) are frequent clinical problems. Although most are benign and nonsecretory, the possibility of malignancy is a concern. We report here a case of adrenocortical carcinoma (ACC) evolving from a small AI, 3 years after initial detection.Methods: We report our case and review similar cases in the literature and current published guidelines for AIs.Results: A 47-year-old woman was incidentally found to have a small (13 mm maximum diameter), homogeneous, left adrenal lesion with low density on computed tomography (CT) performed for abdominal pain. Two years later, she underwent magnetic resonance imaging for back pain; the lesion then measured 20 × 15 × 17 mm and again appeared benign. Ten months later, she developed fatigue, night sweats, anorexia, and weight loss. On CT, the lesion now measured 100 × 90 × 130 mm and was heterogeneous; 18F-fluorodeoxyglucose positron emission tomography showed intense uptake. Tests for hormone hypersecretion were negative. She underwent left adrenalectomy, with symptom resolution. Histology showed ACC with high proliferative index (Ki67 = 40%).Conclusion: This is a rare case of ACC evolving from a small AI after years of latency. This case suggests the possibility of adenoma to carcinoma sequence in the pathogenesis of some ACCs and highlights the challenge in identifying such lesions without unnecessary and potentially harmful testings.Abbreviations: ACC adrenocortical carcinoma; AI adrenal incidentaloma; CT computed tomography; FDG fluorodeoxyglucose; HU Hounsfield unit; MRI magnetic resonance imaging; NR normal range; PET positron emission tomography |
| first_indexed | 2024-12-14T10:08:33Z |
| format | Article |
| id | doaj.art-60cfd2f0f7c947c48d3a9a6de1356687 |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-12-14T10:08:33Z |
| publishDate | 2018-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-60cfd2f0f7c947c48d3a9a6de13566872022-12-21T23:07:04ZengElsevierAACE Clinical Case Reports2376-06052018-01-01416569An Adrenocortical Carcinoma Evolving from A Small Adrenal Incidentaloma after Years of LatencyMoe Thuzar, MBBS, MRCP (UK), FRACP0Donald A. Perry-Keene, MBBS, FRACP1Michael C. d'Emden, MBBS, FRACP, PhD2Emma L. Duncan, MBBS, FRACP, FRCP, PhD3From the Department of Endocrinology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Translational Research Institute, Brisbane, Queensland, AustraliaFrom the Department of Endocrinology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, AustraliaFrom the Department of Endocrinology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, AustraliaFrom the Department of Endocrinology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Woolloongabba, Queensland, Australia.; Address correspondence to Dr. Emma Duncan, Department of Endocrinology, Royal Brisbane & Women's Hospital, Butterfield Street, Herston, Brisbane, Queensland 4029, Australia.ABSTRACT: Objective: Adrenal incidentalomas (AIs) are frequent clinical problems. Although most are benign and nonsecretory, the possibility of malignancy is a concern. We report here a case of adrenocortical carcinoma (ACC) evolving from a small AI, 3 years after initial detection.Methods: We report our case and review similar cases in the literature and current published guidelines for AIs.Results: A 47-year-old woman was incidentally found to have a small (13 mm maximum diameter), homogeneous, left adrenal lesion with low density on computed tomography (CT) performed for abdominal pain. Two years later, she underwent magnetic resonance imaging for back pain; the lesion then measured 20 × 15 × 17 mm and again appeared benign. Ten months later, she developed fatigue, night sweats, anorexia, and weight loss. On CT, the lesion now measured 100 × 90 × 130 mm and was heterogeneous; 18F-fluorodeoxyglucose positron emission tomography showed intense uptake. Tests for hormone hypersecretion were negative. She underwent left adrenalectomy, with symptom resolution. Histology showed ACC with high proliferative index (Ki67 = 40%).Conclusion: This is a rare case of ACC evolving from a small AI after years of latency. This case suggests the possibility of adenoma to carcinoma sequence in the pathogenesis of some ACCs and highlights the challenge in identifying such lesions without unnecessary and potentially harmful testings.Abbreviations: ACC adrenocortical carcinoma; AI adrenal incidentaloma; CT computed tomography; FDG fluorodeoxyglucose; HU Hounsfield unit; MRI magnetic resonance imaging; NR normal range; PET positron emission tomographyhttp://www.sciencedirect.com/science/article/pii/S2376060520304569 |
| spellingShingle | Moe Thuzar, MBBS, MRCP (UK), FRACP Donald A. Perry-Keene, MBBS, FRACP Michael C. d'Emden, MBBS, FRACP, PhD Emma L. Duncan, MBBS, FRACP, FRCP, PhD An Adrenocortical Carcinoma Evolving from A Small Adrenal Incidentaloma after Years of Latency AACE Clinical Case Reports |
| title | An Adrenocortical Carcinoma Evolving from A Small Adrenal Incidentaloma after Years of Latency |
| title_full | An Adrenocortical Carcinoma Evolving from A Small Adrenal Incidentaloma after Years of Latency |
| title_fullStr | An Adrenocortical Carcinoma Evolving from A Small Adrenal Incidentaloma after Years of Latency |
| title_full_unstemmed | An Adrenocortical Carcinoma Evolving from A Small Adrenal Incidentaloma after Years of Latency |
| title_short | An Adrenocortical Carcinoma Evolving from A Small Adrenal Incidentaloma after Years of Latency |
| title_sort | adrenocortical carcinoma evolving from a small adrenal incidentaloma after years of latency |
| url | http://www.sciencedirect.com/science/article/pii/S2376060520304569 |
| work_keys_str_mv | AT moethuzarmbbsmrcpukfracp anadrenocorticalcarcinomaevolvingfromasmalladrenalincidentalomaafteryearsoflatency AT donaldaperrykeenembbsfracp anadrenocorticalcarcinomaevolvingfromasmalladrenalincidentalomaafteryearsoflatency AT michaelcdemdenmbbsfracpphd anadrenocorticalcarcinomaevolvingfromasmalladrenalincidentalomaafteryearsoflatency AT emmalduncanmbbsfracpfrcpphd anadrenocorticalcarcinomaevolvingfromasmalladrenalincidentalomaafteryearsoflatency AT moethuzarmbbsmrcpukfracp adrenocorticalcarcinomaevolvingfromasmalladrenalincidentalomaafteryearsoflatency AT donaldaperrykeenembbsfracp adrenocorticalcarcinomaevolvingfromasmalladrenalincidentalomaafteryearsoflatency AT michaelcdemdenmbbsfracpphd adrenocorticalcarcinomaevolvingfromasmalladrenalincidentalomaafteryearsoflatency AT emmalduncanmbbsfracpfrcpphd adrenocorticalcarcinomaevolvingfromasmalladrenalincidentalomaafteryearsoflatency |