Endocrine Abstracts

Background: Adrenocortical carcinoma (ACC) is a rare cancer that originates from the cortex of the adrenal gland. Although its exact etiology is not clear, it has been found to be associated with some hereditary cancer syndromes. Sometimes patients present with hormonal excess symptoms (virilization, Cushing’s syndrome) or local symptoms consistent with an abdominal mass. In ACC, computed tomography (CT) and magnetic resonance imaging (MRI) are preferred imaging modalities for the localization of the tumor, and the determination of metastases. Myelolipoma, Metastases, lymphoma, and pheochromocytoma should be considered in the differential diagnosis of adrenal carcinoma. Herein, we aimed to present a case of ACC that initially mimics lymphoma with clinical and imaging findings.

Case report: A 42-year-old female presented to our outpatient clinic with a 3-month history of fever (38°C), night sweats, malaise, amenorrhea, abdominal pain, proximal muscle weakness, and deepening of the voice. She was receiving antihypertensive medication therapy. Physical examination revealed peripheral lymphadenopathy and central obesity. Abdominal ultrasonography showed a 164 × 72 mm mass lesion on the paraaortic area. To define the lesion more accurately, we performed abdominal contrast-enhanced MRI which revealed a 200 × 130 × 90 mm conglomerate solid mass with diffusion restriction that mimic bulky lymphadenopathy. On imaging, the appearance of mass was not clearly distinguishable from adrenal glands. Laboratory tests were found to be compatible with Cushing’s syndrome (Table-1). Urinary catecholamines levels were found within normal limits. Thoracic and cervical CT was performed and detected 41 × 34 mm conglomerate lymphadenopathy at the subcarinal and supraclavicular area. An ultrasound-guided percutaneous tru-cut biopsy was performed from the supraclavicular lymph node to confirm the diagnosis. The patient was diagnosed with metastasis of ACC by histopathology and referred for chemotherapy.

Conclusion: Since complete surgical resection is one of the most important factors which prolong survival, it is very important to make an early diagnosis in ACC. When an intra-abdominal mass is detected, a careful examination should be performed to exclude signs and symptoms of pheochromocytoma, hyperaldosteronism, hyperandrogenism, and Cushing’s syndrome. ACC should be kept in mind in case of symptoms of Cushing’s syndromeand/or virilization.

ACTH:Adrenocorticotropic hormone, DST:Dexamethasone suppression test