A Case Report of Bilateral Adrenal Sarcomatoid Carcinoma

Insights into Clinical Features and Outcomes of Adrenal Cortical Carcinosarcoma

Adrenal cortical carcinosarcomas are a rare and typically aggressive malignancy with few reported cases in medical literature. We present a case of a 78-year-old female who presented with complaints of fatigue and right shoulder pain. Imaging of the abdomen with computed tomography visualized a large mass in the right upper quadrant. The mass was radiologically described as a 22 × 17 × 13 cm heterogeneous mass with its epicenter in the area of the right adrenal gland, with medial and peripheral effacement of all structures in the right upper quadrant. Non-contrasted images demonstrated anterior mid-portion calcifications. The mass parasitized its blood supply from several surrounding structures, including the liver and right psoas muscle, and extensively invaded the psoas muscle. Resection of the mass was performed with pathology, which revealed a high mitotic index and nuclear atypia with two morphologically and immunophenotypically distinct components. One of these components stained positively for calretinin and inhibin, which is indicative of adrenal cortical carcinoma; the other exhibited strong expression of vimentin and desmin, which was concordant with sarcomatous change and confirmed the diagnosis of adrenal cortical carcinosarcoma. This unique histology with both carcinomatous and sarcomatous components presents a diagnostic challenge for clinicians. As such, adrenal carcinosarcomas should be kept on the differential when evaluating retroperitoneal masses. Additionally, this study includes a review of 34 previously reported cases of adrenal cortical carcinosarcomas along with a discussion about the future exploration of this pathology.

Metastatic bilateral adrenal sarcomatoid carcinoma: Evaluation by 18F-FDG PET/CT

Sarcomatoid carcinoma of the adrenal gland is an uncommon presentation of malignant adrenal tumors and bilateral presentation is extremely rare. It is an extremely rare occurrence, unusual symptoms, and both epithelioid and sarcomatoid components in histology are a challenge to diagnose sarcomatoid carcinoma of adrenal origin. The majority of patients are diagnosed at a later stage while having metastatic disease and succumb due to disease within a few months of diagnosis due to the aggressive nature of the disease. Probably due to the advanced disease at the time of diagnosis; patients diagnosed having adrenal sarcomatoid tumor have a very poor prognosis. In nonmetastatic disease, adjuvant chemotherapy is suggested after the removal of the tumor. It is essential to diagnose these tumors earliest to treat with effective treatment modalities. The present study describes the rare case of sarcomatoid carcinoma involving the bilateral adrenal gland with metastasis to bones, lymph nodes, and pleura evaluated by ¹⁸F-FDG PET/CT.

Bilateral adrenal tumor: A case report and current challenges

INTRODUCTION

A bilateral adrenal tumor is a rare case. It differs significantly from unilateral adrenal mass since it is related strongly to genetic and family history. Adrenocortical Carcinoma might cause related hormonal syndromes such as Cushing syndrome, Conn syndrome, and virilization.

AIM

This study aims to report an uncommon presentation of a 15-year-old female with bilateral Adrenal Tumor since an early age with virilization as the main symptoms.

CASE PRESENTATION

The patient is a 15-year-old girl with female genitalia presentation. She complained of a bulging mass on her right flank with pain four years ago. The mass size grew progressively and initially painless. However, the patient started to feel pain a year ago. Since she was six years old, the mass started to appear on the left flank, and then it also started to appear on the right side. The mass appearance is simultaneous with virilization symptom development, such as the emergence of facial hair, mustache, and sideburns. In 2020, MRI showed a lesion on the right suprarenal with contrast enhancement with 14.5 × 11.5 cm in size, and a 5.6 × 4 cm recurrent left suprarenal lesion. The patient underwent right adrenalectomy resection surgery on January 21st, 2021. The immunohistochemistry examination suggested Adrenocortical Carcinoma.

CONCLUSION

Adrenocortical Carcinoma is a hormone-secreting tumor that might affect the patient's condition systematically. Neglected cases of adrenal cortical carcinoma might affect secondary sexual organ development in the long term. Thus, an early diagnosis and treatment are paramount for this case.

Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging

Adrenocortical carcinoma (ACC) is a heterogenous group of diseases with different clinical behaviour between adult and paediatric patients. In addition, three histological variants, oncocytic, myxoid and sarcomatoid are noted on the recent World Health Organisation (WHO) classification of ACC. A review of recent literature showed that the different types of ACC have distinctive demographic data, clinical presentation, pathology, biological behaviour, genomic and patients' prognosis. In addition, recent updates of pathology staging for ACC allow refinement of prognostic grouping for planning treatment of the patients with ACC. These advances in genomic, pathology and staging have driven the development of standardisation of pathology reporting. International standardisation of pathological reporting of adrenocortical carcinoma and adaption to local pathology communities provide universal platforms for clinicians and researchers involved in the management of patients with ACC. To conclude, all these advances in the field of pathology will improve development of management strategies including improvement of clinical care, development of prognostic markers and testing of novel therapeutic approaches for patients with adrenocortical carcinoma.

Adrenocortical sarcomatoid carcinoma: a case report and review of the literature

Adrenal sarcomatoid carcinoma (ASC) is a very rare aggressive variant of adrenocortical carcinoma showing carcinomatous and sarcomatous differentiation. It is a poorly differentiated carcinoma with poor prognosis. The diagnosis requires careful histological and immunohistochemical investigation. We describe a new case of ASC to raise awareness on this extremely rare entity. A 27-year-old woman presented with a right flank pain. Imaging revealed a tissular mass of the right adrenal gland without metastases. After adrenalectomy, histology revealed sheets of epithelioid cells that stained for synaptophysin and Melan-A; and spindled cells staining for S-100. We have reported the clinical and histopathological features of ACS’s case; as it is an extremely rare cancer with a challenging diagnosis. There is a need for a further understanding of ASC’s biology to improve it poor prognosis.