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Lee, Kwak, Kim, Kim, Lee, Lee, Kim, Kim, Chung, Lee, and Han: A Case of an Adrenocortical Carcinoma with Pulmonary Embolism as the Initial Manifestation
Case Report
Endocrinology and Metabolism

Endocrinology and Metabolism 2012; 27(1): 93-97.

Published online: 21 March 2012

DOI: https://doi.org/10.3803/EnM.2012.27.1.93

A Case of an Adrenocortical Carcinoma with Pulmonary Embolism as the Initial Manifestation

Hyo Jin Lee, Ji Young Kwak, Young Jip Kim, Tae Ho Kim1, Jan Dee Lee2, Hyun Woo Lee3, Hae Jin Kim, Dae Jung Kim, Yoon Sok Chung, Kwan Woo Lee, Seung Jin Han

Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.

1Department of Endocrinology and Metabolism, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.

2Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

3Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea.

Corresponding author: Seung Jin Han. Department of Endocrinology and Metabolism, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 443-721, Korea. Tel: +82-31-219-5126, Fax: +82-31-219-4497, hsj@ajou.ac.kr

Received 2 June 2011       Accepted 10 October 2011

Copyright © 2012 Korean Endocrine Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The annual incidence of a first episode of deep vein thrombosis or pulmonary embolism (PE) in the general population is 120 per 100,000. Cancer is associated with an approximately 4- to 7-fold higher risk of thrombosis. Adrenocortical carcinoma (ACC) is a rare type of malignancy, accounting for 0.02% of all cancers reported annually. Approximately 40% of ACCs are nonsecretory. Most patients with nonsecreting tumors have clinical manifestations related to tumor growth (e.g., abdominal or flank pain). Often the adrenal mass is detected by chance via radiographic imaging. As a result, most ACC patients are diagnosed at an advanced stage and have a poor prognosis. Herein, we report a case of a 54-year-old woman who was admitted to our emergency department complaining of dyspnea. She was diagnosed with ACC accompanied by thrombi in the pulmonary artery and inferior vena cava. We performed a left adrenalectomy and administered adjuvant radiotherapy. The patient is currently receiving warfarin and adjuvant mitotane therapy. She was incidentally diagnosed with ACC, with PE as the initial manifestation.

Keywords: Adrenal mass, Adrenocortical carcinoma, Pulmonary thromboembolism

Figures and Tables

Fig. 1
A. Chest computed tomography. Pulmonary embolism. Multiple filling defects in the lobar and segmental pulmonary arteries in both lungs. B. Abdominal computed tomography. 10-cm sized heterogenously enhancing mass is demonstrated in the suprarenal area. Left renal vein thrombosis is also noted. C. T2 weighted image of the abdominal magnetic resonance imaging. Tumor thrombus is noted in the left renal vein and some part of inferior C vena cava.
enm-27-93-g001
Fig. 2
A. Resected adrenal gland. Weighing 277 g, measuring 12 × 9.5 × 4.5 cm. It has revealing a necrotic mass, which shows yellowish soft solid cut surface. There are multifocal hemorrhagic and necrotic areas. B. Histology of the resected adrenal gland. The histologic findings are nuclear pleomorphism, hyperchromasia and cytoplasmic eosinophilia (H&E stain, × 400).
enm-27-93-g002

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