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Cárdenas-Salas J, Castelo B, Regojo RM, González-Sanchez JA, Álvarez-Escolá C. Long-term complete remission of metastatic adrenocortical carcinoma. Horm Mol Biol Clin Investig 2022; 44:67-71. [PMID: 36069780 DOI: 10.1515/hmbci-2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/20/2022] [Indexed: 11/15/2022]
Abstract
OBJETIVES To report a rare case of a metastatic adrenocortical carcinoma (ACC) that achieve a complete and a long-term remission. CASE PRESENTATION AAC is a rare and aggressive tumor, with a high risk of recurrence and that present metastases in 21% of cases at diagnosis. Treatment of advanced ACC is challenging, mitotane is the only available adrenolytic treatment, with modest and unpredictable responses. Response rates to systemic chemotherapy are not encouraging. We describe the case of a 39-year-old woman with a metastatic ACC, that achieve a complete and long-term remission after chemotherapy, mitotane treatment and surgery of primary tumor and liver metastases. CONCLUSIONS A complete remission of a metastatic adrenocortical carcinoma is possible in some rare cases after a multimodal treatment.
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Affiliation(s)
- Jersy Cárdenas-Salas
- Department of Endocrinology, "Fundación Jiménez-Diaz" University Hospital, Madrid, Spain
| | - Beatriz Castelo
- Department of Oncology, "La Paz" University Hospital, Madrid, Spain
| | - Rita María Regojo
- Department of Pathology, "La Paz" University Hospital, Madrid, Spain
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Kwok GTY, Zhao JT, Glover AR, Gill AJ, Clifton-Bligh R, Robinson BG, Ip JCY, Sidhu SB. microRNA-431 as a Chemosensitizer and Potentiator of Drug Activity in Adrenocortical Carcinoma. Oncologist 2019; 24:e241-e250. [PMID: 30918109 DOI: 10.1634/theoncologist.2018-0849] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare endocrine cancer with treatments limited in efficacy for metastatic disease. New molecular targeted therapies have yet to improve patient outcomes. In contrast, established treatment regimens of adrenolytics and chemotherapy have demonstrated treatment benefit, although admittedly in a minority of patients. Identification of microRNAs (miRNAs) in patients responsive to adjuvant therapy may offer a means to sensitize patients with progressive disease to existing adjuvant regimens. MATERIALS AND METHODS Samples from primary ACC tumors of 10 Stage IV patients were examined for differentially expressed miRNAs between a "sensitive" and "resistant" cohort. Candidate microRNAs were restored via transfection in two functional ACC cell lines. Gain of function and effects on apoptosis and cell cycle were assessed. RESULTS microRNA-431 (miR-431) was underexpressed in patients with ACC with progressive disease undergoing adjuvant therapy. Restoration of miR-431 in vitro decreased the half maximal inhibitory concentrations of doxorubicin and mitotane, with markedly increased apoptosis. We found that a reversal of epithelial-mesenchymal transition underlies the action of miR-431 with doxorubicin treatment, with Zinc Finger E-Box Binding Homeobox 1 implicated as the molecular target of miR-431 in ACC. CONCLUSION This is the first report of the potential of miRNA therapy to sensitize ACC to current established adjuvant therapy regimens, which may mitigate the resistance underlying treatment failure in patients with advanced ACC. Effective and well-studied methods of targeted miRNA delivery in existence hints at the imminent translatability of these findings. IMPLICATIONS FOR PRACTICE Adrenocortical carcinoma (ACC) is a rare endocrine cancer with outcomes not improving despite extensive research and new targeted therapies. Mitotane and etoposide/doxorubicin/cisplatin chemotherapy is trial validated for improved recurrence-free survival. However, a minority of patients experience sustained benefit. Significant side effects exist for this regimen, with patients often unable to attain target drug doses shown to give survival benefit. This preclinical study examines the role of microRNAs in sensitizing ACC to doxorubicin or mitotane. This study offers an important bridge between new and existing cancer treatments, offering an imminently translatable approach to the treatment of adrenocortical carcinoma.
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Affiliation(s)
- Grace T Y Kwok
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Jing Ting Zhao
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Anthony R Glover
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
- Department of Endocrinology, Royal North Shore Hospital and University of Sydney, St Leonards, Sydney, New South Wales, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards and University of Sydney, Sydney, New South Wales, Australia
| | - Roderick Clifton-Bligh
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
- Sydney Medical School Northern, Royal North Shore Hospital, University of Sydney, St Leonards, Sydney, New South Wales, Australia
- Department of Endocrinology, Royal North Shore Hospital and University of Sydney, St Leonards, Sydney, New South Wales, Australia
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, Sydney, St Leonards, Sydney, New South Wales, Australia
| | - Bruce G Robinson
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
- Department of Endocrinology, Royal North Shore Hospital and University of Sydney, St Leonards, Sydney, New South Wales, Australia
| | - Julian C Y Ip
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Stan B Sidhu
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, Sydney, St Leonards, Sydney, New South Wales, Australia
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Kou K, Zhang H, Zhang C, Xie E, Chen Y, Wang G, Lv G. A case of adrenocortical carcinoma accompanying secondary acute adrenal hypofunction postoperation. World J Surg Oncol 2018; 16:43. [PMID: 29506536 PMCID: PMC5836435 DOI: 10.1186/s12957-018-1326-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/30/2018] [Indexed: 02/24/2023] Open
Abstract
Background Adrenocortical carcinoma (ACC) is a rare, heterogeneous malignancy with a poor prognosis. ACCs are classified as functioning and non-functioning. The pathogenesis of ACC remains elusive, and diagnosis of ACC is currently based on pathology. In the absence of other effective approaches, surgical resection is the preferred treatment option. Case presentation Here, we report a case of ACC in the retroperitoneum. The patient underwent radical adrenalectomy and remained disease-free throughout a 6-month follow-up. Conclusions Radical surgical resection is an efficient therapy for ACC, and hydrocortisone can be used to alleviate symptoms of secondary acute adrenal hypofunction.
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Affiliation(s)
- Kai Kou
- Department of Hepatobiliary and Pancreatic Surgery, Bethune Hospital 1, Changchun, Jilin, 130021, China
| | - Haiwen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Bethune Hospital 1, Changchun, Jilin, 130021, China
| | - Conggui Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Bethune Hospital 1, Changchun, Jilin, 130021, China
| | - Enbo Xie
- Department of Hepatobiliary and Pancreatic Surgery, Bethune Hospital 1, Changchun, Jilin, 130021, China
| | - Yuguo Chen
- Department of Hepatobiliary and Pancreatic Surgery, Bethune Hospital 1, Changchun, Jilin, 130021, China
| | - Guangyi Wang
- Department of Hepatobiliary and Pancreatic Surgery, Bethune Hospital 1, Changchun, Jilin, 130021, China
| | - Guoyue Lv
- Department of Hepatobiliary and Pancreatic Surgery, Bethune Hospital 1, Changchun, Jilin, 130021, China.
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El Ghorayeb N, Rondeau G, Latour M, Cohade C, Olney H, Lacroix A, Perrotte P, Sabourin A, Mazzuco TL, Bourdeau I. Rapid and Complete Remission of Metastatic Adrenocortical Carcinoma Persisting 10 Years After Treatment With Mitotane Monotherapy: Case Report and Review of the Literature. Medicine (Baltimore) 2016; 95:e3180. [PMID: 27043680 PMCID: PMC4998541 DOI: 10.1097/md.0000000000003180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mitotane has been used for more than 5 decades as therapy for adrenocortical carcinoma (ACC). However its mechanism of action and the extent of tumor response remain incompletely understood. To date no cases of rapid and complete remission of metastatic ACC with mitotane monotherapy has been reported. A 52-year-old French Canadian man presented with metastatic disease 2 years following a right adrenalectomy for stage III nonsecreting ACC. He was started on mitotane which was well tolerated despite rapid escalation of the dose. The patient course was exceptional as he responded to mitotane monotherapy after only few months of treatment. Initiation of chemotherapy was not needed and he remained disease-free with good quality of life on low maintenance dose of mitotane during the following 10 years. A germline heterozygous TP53 exon 4 polymorphism c.215C>G (p. Pro72Arg) was found. Immunohistochemical stainings for IGF-2 and cytoplasmic β-catenin were positive. Advanced ACC is an aggressive disease with poor prognosis and the current therapeutic options remain limited. These findings suggest that mitotane is a good option for the treatment of metastatic ACC and might result in rapid complete remission in selected patients.
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Affiliation(s)
- Nada El Ghorayeb
- From the Division of Endocrinology (NEG, GR, AL, IB), Department of Medicine; Department of Pathology (ML); Division of Nuclear Medicine (CC), Department of Radiology; Division of Oncology (HO), Department of Medicine; Division of Urology (PP), Department of Surgery; Division of Endocrinology (AS), Department of Medecine, Hôpital Honoré Mercier, Saint-Hyacinthe, Québec, Canada; and Division of Endocrinology (TLM), Medical Clinical Department, Health Sciences Centre, Universidade Estadual de Londrina (UEL), Paraná, Brazil
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Nakano R, Satoh D, Nakajima H, Yoshimura Y, Miyoshi H, Yoshida K, Matsukawa H, Shiozaki S, Ichimura K, Okajima M, Ninomiya M. Repeated resections for liver metastasis from primary adrenocortical carcinoma: A case report. Int J Surg Case Rep 2015; 9:119-22. [PMID: 25765741 PMCID: PMC4392357 DOI: 10.1016/j.ijscr.2015.02.041] [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: 02/07/2015] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 11/29/2022] Open
Abstract
Adrenal cortical carcinoma (ACC) is rare, often recurring, and has a poor prognosis. Surgery remains the optimal treatment for ACC, due to chemotherapy’s ineffectiveness. Our patient developed 2 liver metastases after right adrenalectomy (1.5 and 4 years). Therefore, complete surgical resection should be considered in similar cases.
Introduction Adrenal cortical carcinoma (ACC) is a very rare type of tumor that generally has a poor prognosis. Little has been reported on repeated liver resections with recurrent metastasis still confined to the liver. In this report, we describe a case of functioning ACC in a 65-year-old woman with 2 liver metastases of the ACC (at 1.5 and 4 years) after the right adrenalectomy. Presentation of case A 65-year-old woman was referred to our hospital based on a suspicion of hyperaldosteronism. Abdominal computed tomography revealed a lesion at the right adrenal gland; therefore, we performed right adrenalectomy and subsequently diagnosed the lesion as ACC. However, follow-up computed tomography at 1.5 and 4 years after the right adrenalectomy revealed liver metastasis of ACC; liver resection was performed for both metastases. Discussion Complete surgical resection is the established approach for the treatment of ACC. The prognosis of ACC is usually dismal, and recurrence rates of up to 85% have been reported. However, the appropriate treatment for recurrent ACC is not well established, and the effectiveness of other modalities, such as chemotherapy and radiotherapy, is not proven. Therefore, surgical resection may currently be the most appropriate treatment modality, as the patient achieved a disease-free interval of 2.5 years after the first liver resection. Conclusion In selected patients with recurrent or metastatic ACC, resection is likely to be associated with prolonged survival. However, a full cure is generally not achievable, and a multidisciplinary approach is likely needed to achieve long-term disease-free status and survival.
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Affiliation(s)
- Ryosuke Nakano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
| | - Daisuke Satoh
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hirochika Nakajima
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yuri Yoshimura
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hisanobu Miyoshi
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kazuhiro Yoshida
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hiroyoshi Matsukawa
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Shigehiro Shiozaki
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kouichi Ichimura
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Masazumi Okajima
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Motoki Ninomiya
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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Hughes JW, Guess MK, Hittelman A, Yip S, Astle J, Pal L, Inzucchi SE, Dulay AT. Clitoral epidermoid cyst presenting as pseudoclitoromegaly of pregnancy. AJP Rep 2013; 3:57-62. [PMID: 23943712 PMCID: PMC3699154 DOI: 10.1055/s-0033-1334461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 01/02/2013] [Indexed: 11/09/2022] Open
Abstract
Objective Acquired clitoromegaly is rare and may result from hormonal and nonhormonal causes, and evaluation of the pregnant patient with clitoromegaly invokes a specific set of differential diagnoses. Methods Case report. Results We describe the case of a young woman with pregnancy-associated clitoral enlargement whose hormonal evaluation proved negative. Further investigation concluded that an epidermoid cyst was the culprit of her pseudoclitoromegaly. The patient underwent successful surgical resection and has had no recurrence at her subsequent pregnancy. Conclusion We review the differential diagnosis of clitoromegaly, including hormonal and nonhormonal causes, with focus on the evaluation of pregnancy-associated clitoromegaly.
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Affiliation(s)
- Jing W Hughes
- Section of Endocrinology and Metabolism, Yale University School of Medicine, New Haven, Connecticut
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Aghamohammadzadeh N, Faraji A, Bozorgi F, Faraji I, Moghadaszadeh M. Primary hyperaldostronisim as initial presentation of adrenal cortical carcinoma with liver metastasis: a case report. Int J Hematol Oncol Stem Cell Res 2013; 7:38-42. [PMID: 24505527 PMCID: PMC3913141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/06/2013] [Indexed: 11/21/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare tumor and usually a fatal disease which can develop at any age in either sex. Differential diagnosis between malignant and benign adrenal mass is not easy which leads to significant clinical challenge for optimal treatment. Here we report a 22-year-old woman diagnosed with primary hyper aldostronism initially but disease relapsed during six months and magnetic resonance imaging revealed tumor with metastasis to the liver.
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Affiliation(s)
- Naser Aghamohammadzadeh
- Assistant Professor, Endocrinology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afsaneh Faraji
- Medical Student, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farshid Bozorgi
- Anatomical and Clinical Pathologist, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ismail Faraji
- Internist, fellow of Endocrinology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Moghadaszadeh
- Resident of Internal Medicine, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding author: Majid Moghadaszadeh, MD, Internal Medicine Department, Tabriz University of Medical Sciences, Tabriz, Iran. Tel: +989144141359. E-mail:
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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
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