1
|
Rich JM, Duddalwar V, Cheng PM, Aron M, Daneshmand S. Feminizing Adrenocortical Tumor with Multiple Recurrences: A Case Report. Case Rep Oncol 2023; 16:1033-1040. [PMID: 37900824 PMCID: PMC10601808 DOI: 10.1159/000533835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/24/2023] [Indexed: 10/31/2023] Open
Abstract
Feminizing adrenocortical tumors (FATs) are exceptionally rare primary adrenal neoplasms that cause high estrogen and low testosterone levels. They are most common in adult males, typically presenting with gynecomastia, hypogonadism, and weight loss. They are almost always malignant, with a poor prognosis and a high recurrence rate. We report a case of a 35-year-old man with an adrenal FAT with high estrogen (181 pg/mL) and low testosterone (37 ng/dL) who presented with gynecomastia, erectile dysfunction, subclinical Cushing syndrome, and pain localizing to different regions of the torso. There was no evidence of metastatic disease initially as seen by visualization of a well-marginated mass on computed tomography scan. Surgical resection of the FAT was performed, and the mass was confirmed to be a low-grade tumor. Clinical symptoms were resolved after surgery. Despite complete resection with negative margins, the patient subsequently had two separate local metastatic recurrences within a few years, treated with a combination of further surgery and medical intervention. This case highlights the unique features of an exceedingly rare adrenal tumor and stresses the importance of early detection and vigilant surveillance following resection due to high recurrence rates.
Collapse
Affiliation(s)
- Joseph M. Rich
- MD/PhD Program, USC-Caltech MD/PhD Program, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Vinay Duddalwar
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- USC Radiomics Laboratory, Keck School of Medicine, Department of Radiology, University of Southern California, Los Angeles, CA, USA
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Phillip M. Cheng
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Manju Aron
- Department of Pathology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Siamak Daneshmand
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
2
|
Abstract
Background: Feminizing adrenal tumors are rare and generally malignant tumors usually seen in male adults and children. We report the case of a benign feminizing adrenal tumor in a male patient. To our knowledge, only 2 other cases of benign, estrogen-only-secreting adrenal tumors have been reported. Case Report: A 44-year-old male with a history of hypertension presented to his primary care physician with chest tenderness, fatigue, and erectile dysfunction. Hormonal workup and imaging identified an estrogen-only-secreting adrenal adenoma. The adenoma was removed via laparoscopic adrenalectomy, and the patient had a normal postoperative course. Pathologic findings were an adrenal cortical adenoma with a Weiss score of 0 and a Ki-67 score of 0%. At 6-month follow-up, the patient's symptoms had significantly improved, and his previously abnormal sex hormone levels were within normal limits. Conclusion: Given the ambiguity in distinguishing between malignant and benign feminizing adrenal tumors, we suggest that radiologic (via Hounsfield units), clinical (via trending hormone levels), and histopathologic (via Weiss and Ki-67 scores) findings are sufficient to confirm the benign nature of this commonly malignant tumor.
Collapse
|
3
|
Jeong Y, Cho SC, Cho HJ, Song JS, Kong JS, Park JW, Ku YH. Estrogen-secreting adrenocortical carcinoma. Yeungnam Univ J Med 2018; 36:54-58. [PMID: 31620613 PMCID: PMC6784621 DOI: 10.12701/yujm.2019.00017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/09/2018] [Accepted: 09/11/2018] [Indexed: 11/17/2022] Open
Abstract
Adrenocortical carcinoma is a rare type of endocrine malignancy with an annual incidence of approximately 1–2 cases per million. The majority of these tumors secrete cortisol, and a few secrete aldosterone or androgen. Estrogen-secreting adrenocortical carcinomas are extremely rare, irrespective of the secretion status of other adrenocortical hormones. Here, we report the case of a 53-year-old man with a cortisol and estrogen-secreting adrenocortical carcinoma. The patient presented with gynecomastia and abdominal discomfort. Radiological assessment revealed a tumor measuring 21×15.3×12 cm localized to the retroperitoneum. A hormonal evaluation revealed increased levels of estradiol, dehydroepiandrosterone sulfate, and cortisol. The patient underwent a right adrenalectomy, and the pathological examination revealed an adrenocortical carcinoma with a Weiss’ score of 6. After surgery, he was treated with adjuvant radiotherapy. Twenty-one months after treatment, the patient remains alive with no evidence of recurrence.
Collapse
Affiliation(s)
- You Jeong
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Sung Chul Cho
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Hee Joon Cho
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Ji Soo Song
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Joon Seog Kong
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Jong Wook Park
- Department of Urology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Yun Hyi Ku
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| |
Collapse
|
4
|
Wang Y, Zhou F, Pan H, Jin B. Adrenal cortical carcinoma with tumor thrombus extension into the right atrium: A case report. Oncol Lett 2016; 11:3987-3991. [PMID: 27313728 PMCID: PMC4888244 DOI: 10.3892/ol.2016.4502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/01/2016] [Indexed: 11/06/2022] Open
Abstract
Adrenal cortical carcinoma (ACC) is a rare aggressive malignant tumor associated with a poor prognosis. Patients with ACC usually present with abnormal hormone secretion, tumor growth or encroachment on the surrounding viscera. An early diagnosis of ACC is considered challenging. The present study reports a case of ACC with tumor thrombus extension into the inferior vena cava and right atrium. A 33-year-old male patient exhibited symptoms of gynecomastia and abdominal distention, which were due to the abnormal hormone secretion levels and to the presence of a large mass in the right adrenal gland. An en bloc resection of the tumor was the selected treatment option. Extirpation of the tumor thrombus was performed by means of extracorporeal circulation. No signs of metastasis or recurrence were identified at the 1-month follow-up.
Collapse
Affiliation(s)
- Yimin Wang
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Feng Zhou
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Hao Pan
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Baiye Jin
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| |
Collapse
|
5
|
Feminizing adrenal tumor in a 6-year-old boy. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2016. [DOI: 10.1016/j.epag.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
6
|
Abstract
Feminizing adrenal tumors (FAT) are extremely rare tumors prevailing in males. Clinical manifestations are gynecomastia and/or other hypogonadism features in adults. They are rarer in pediatric population and their main manifestation is peripheral sexual precocity. In women genital bleeding, uterus hypertrophy, high blood pressure and/or abdomen mass may be the only manifestations. On the biological point, estrogen overproduction with or without increase in other adrenal hormones are the main abnormalities. Radiological examination usually shows the tumor, describes its limits and its eventual metastases. Adrenal and endocrine origins are confirmed by biochemical assessments and histology, but that one is unable to distinguish between benign and malignant tumors, except if metastases are already present. Immunostaining using anti-aromatase antibodies is the only tool that distinguishes FAT from other adrenocortical tumors. Abdominal surgery is the best and the first line treatment. For large tumors (≥10 cm), an open access is preferred to coeliosurgery, but for the small ones, or when the surgeon is experienced, endoscopic surgery seems to give excellent results. Surgery can be preceded by adrenolytic agents such as ortho paraprime dichloro diphenyl dichloroethane (Mitotane), ketoconazole or by aromatase inhibitors, but till now there is not any controlled study to compare the benefit of different drugs. New anti-estrogens can be used too, but their results need to be confirmed in malignant tumors resistant to classical chemotherapy and to conventional radiotherapy. Targeted therapy can be used too, as in other adrenocortical tumors, but the results need to be confirmed.
Collapse
Affiliation(s)
- Farida Chentli
- Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria
| | - Ilyes Bekkaye
- Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria
| | - Said Azzoug
- Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria
| |
Collapse
|
7
|
Fancellu A, Pinna A, Porcu A. Feminizing Adrenocortical Carcinoma with Distant Metastases: Can Surgery be Considered? Clin Pract 2014; 4:651. [PMID: 25332762 PMCID: PMC4202184 DOI: 10.4081/cp.2014.651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/12/2014] [Indexed: 02/08/2023] Open
Abstract
Functioning adrenocortical carcinomas are rare diseases with dismal prognosis. A 41-year-old man presenting with gynecomastia had a giant feminizing adrenocortical carcinoma at stage IV. Although surgical resection was controversial, we removed the primary tumor to reduce the mass effects. He lived for 12 months with an acceptable quality of life. Gynecomastia may be the first sign of feminizing adrenal malignancies. Surgery may ameliorate the quality of life in selected patients with metastatic disease.
Collapse
Affiliation(s)
- Alessandro Fancellu
- Unit of General Surgery 2, Department of Clinical and Experimental Medicine, University of Sassari , Italy
| | - Antonio Pinna
- Unit of General Surgery 2, Department of Clinical and Experimental Medicine, University of Sassari , Italy
| | - Alberto Porcu
- Unit of General Surgery 2, Department of Clinical and Experimental Medicine, University of Sassari , Italy
| |
Collapse
|
8
|
Farida C, Ilyes B, Smina Y, Sabrina S, Soumeya FN, Said A. Feminizing adrenal tumors: Our experience about three cases. Indian J Endocrinol Metab 2013; 17:509-513. [PMID: 23869312 PMCID: PMC3712386 DOI: 10.4103/2230-8210.111669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Feminizing adrenal tumors (FATs) are very rare as they account for less than 2% of all the adrenal neoplasms. Their prognosis is deemed to be very poor. We aimed to present a mono centre (adult and pediatric) experience over a long period of time (January 1980 to Jun 2012). During the study period, we observed only three cases in men aged 22 (2 cases) and 45 (1 case). They all consulted for a painful gynecomastia, decreased libido and impotency. Estradiol was high in two cases at presentation, and after a relapsing tumor in the third one. All had big adrenal tumors (5.9, 6, and 17 cm), and a mixed secretion composed by high estradiol and cortisol. The pathological study argued for malignancy in two cases. But, only one had diffuse metastasis and died 4 years after diagnosis; the others diagnosed one and three years ago are still alive without any metastasis or relapsing.
Collapse
Affiliation(s)
- Chentli Farida
- Department of Endocrine, and Metabolic Diseases, Bab El Oued Hospital, 5boulevard Said Touati, Algiers, Algeria
| | - Bekkaye Ilyes
- Department of Endocrine, and Metabolic Diseases, Bab El Oued Hospital, 5boulevard Said Touati, Algiers, Algeria
| | - Yahiaoui Smina
- Department of Endocrine, and Metabolic Diseases, Bab El Oued Hospital, 5boulevard Said Touati, Algiers, Algeria
| | - Souidi Sabrina
- Department of Endocrine, and Metabolic Diseases, Bab El Oued Hospital, 5boulevard Said Touati, Algiers, Algeria
| | - Fedala Nora Soumeya
- Department of Endocrine, and Metabolic Diseases, Bab El Oued Hospital, 5boulevard Said Touati, Algiers, Algeria
| | - Azzoug Said
- Department of Endocrine, and Metabolic Diseases, Bab El Oued Hospital, 5boulevard Said Touati, Algiers, Algeria
| |
Collapse
|
9
|
Kidd MT, Karlin NJ, Cook CB. Feminizing adrenal neoplasms: case presentations and review of the literature. J Clin Oncol 2010; 29:e127-30. [PMID: 21115870 DOI: 10.1200/jco.2010.31.4799] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
10
|
Moreno S, Guillermo M, Decoulx M, Dewailly D, Bresson R, Proye C. Feminizing adreno-cortical carcinomas in male adults. A dire prognosis. Three cases in a series of 801 adrenalectomies and review of the literature. ANNALES D'ENDOCRINOLOGIE 2006; 67:32-8. [PMID: 16596055 DOI: 10.1016/s0003-4266(06)72537-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED We describe the clinical presentation, biochemical features, diagnostic criteria, clinical course and differential diagnosis in three cases of feminizing adreno-cortical carcinoma (FACC) with a review of the literature. PATIENTS From 1970 throughout December 2003 among a series of 801 adrenalectomies, three had been performed for FACC. RESULTS Age at presentation was 74, 63 and 23 years. Estradiol hypersecretion was observed in 3/3 patients, 17 OH progesterone was elevated in 2/3 patients and both of them had a diminution of testosterone, delta 4 androstenedione was elevated in 1/3 patients. Imaging studies suggested malignancy in 3/3 patients by the presence of necrosis, heterogeneity, calcifications, size of the tumor and compression of adjacent organs. All patients were stage III at presentation and had a Weiss score >or=6. Size and weight of the tumors were 30, 20, 15cm and 3750, 480 and 275g respectively. All 3 patients received mitotane and cortisone post-operatively and at follow up (7, 3 and 2 years) all 3 died of the disease. CONCLUSIONS Feminizing adreno-cortical carcinomas in adults are exceedingly rare (1-2% of adreno-cortical carcinomas). Tumors are huge and even after surgery for cure their prognosis is worse than for other varieties of adreno-cortical carcinomas either secreting or non secreting. Early diagnosis and treatment may improve overall prognosis.
Collapse
Affiliation(s)
- S Moreno
- Clinique Chirurgicale, Service de Chirurgie Générale et Endocrinienne, Université de Lille, Hôpital Claude Huriez, France.
| | | | | | | | | | | |
Collapse
|
11
|
Tritos NA, Cushing GW, Heatley G, Libertino JA. Clinical Features and Prognostic Factors Associated with Adrenocortical Carcinoma: Lahey Clinic Medical Center Experience. Am Surg 2000. [DOI: 10.1177/000313480006600115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Adrenocortical carcinoma is a rare tumor associated with a commonly poor prognosis. However, data on the natural history and response to therapy of patients with this malignancy have often been conflicting. Our objective of this retrospective study was to evaluate the clinical course and survival of patients with adrenocortical carcinoma and to identify relevant prognostic factors. Between 1966 and 1996, 31 patients with histologically documented adrenocortical carcinoma were observed at the Lahey Clinic Medical Center. Patient information was obtained from chart review. At the time of diagnosis, 48 per cent of patients had endocrine symptoms with compatible hormonal studies, 19 per cent had involvement of the inferior vena cava by tumor thrombus, and 32 per cent had metastatic disease. The median survival time was 17 months (range, 1–205 months) for the entire group, and the 5-year survival rate was 26 per cent. Age <54 years, absence of metastatic disease at the time of diagnosis, and completeness of surgical resection were associated with better prognosis. Evaluation of survival with the Cox proportional hazards model suggested that age <54 years, absence of metastatic disease, and nonfunctioning tumor status were independently associated with improved survival. The prognosis of patients with adrenocortical carcinoma is poor but appears more favorable in patients <54 years, with localized disease, or nonfunctioning tumor status. Complete tumor resection may be associated with improved survival.
Collapse
Affiliation(s)
- Nicholas A. Tritos
- Section of Endocrinology and Metabolism, Lahey Clinic Medical Center, Burlington, Massachusetts
| | - Gary W. Cushing
- Section of Endocrinology and Metabolism, Lahey Clinic Medical Center, Burlington, Massachusetts
| | - Gerald Heatley
- Department of Statistics, Lahey Clinic Medical Center, Burlington, Massachusetts
| | - John A. Libertino
- Institute of Urology, Lahey Clinic Medical Center, Burlington, Massachusetts
| |
Collapse
|