Endocrinol Metab.  2012 Mar;27(1):93-97. 10.3803/EnM.2012.27.1.93.

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

• Lee HJ
• Kwak JY
• Kim YJ
• Kim TH
• Lee JD
• Lee HW
• Kim HJ
• Kim DJ
• Chung YS
• Lee KW
• Han SJ

• KMID: 2134826
• DOI: http://doi.org/10.3803/EnM.2012.27.1.93

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.

Keyword

Adrenal mass; Adrenocortical carcinoma; Pulmonary thromboembolism

MeSH Terms

Accounting
Adrenalectomy
Adrenocortical Carcinoma
Dyspnea
Emergencies
Female
Humans
Incidence
Middle Aged
Mitotane
Prognosis
Pulmonary Artery
Pulmonary Embolism
Radiotherapy, Adjuvant
Thrombosis
Vena Cava, Inferior
Venous Thrombosis
Warfarin
Mitotane
Warfarin

Figure

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  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.

• 

  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).

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