Recurrent adrenocortical carcinoma after laparoscopic resection.

BACKGROUND

A 53-year-old man presented with left-sided flank pains to the Gastroenterology department of our clinic in September 2004. A left adrenal mass of 6.5 cm by 7.5 cm was detected by a CT scan. The patient showed no evidence of Cushing's syndrome, and had normal blood pressure and potassium levels. Endocrine tests ruled out excess levels of aldosterone or catecholamines. The patient underwent laparoscopic surgery to remove the tumor mass; histologic work-up revealed an adrenocortical carcinoma. A fluorodeoxyglucose (FDG)-PET scan 1 month, and a CT scan 8 months postoperatively showed no pathologic findings. The patient, however, again presented with left-sided flank pain to our Endocrinology department in August 2005.

INVESTIGATIONS: In our department, laboratory work-up for endocrine activity was performed, as well as CT scans of the adrenal region, and FDG-PET scans in order to determine the extension of disease. Histologic work-up of the removed tumor tissue was performed.

DIAGNOSIS: Recurrent adrenocortical carcinoma after laparoscopic adrenalectomy.

MANAGEMENT: In our department, 10 months after initial laparoscopic surgery, local tumor recurrence was treated by repeated extensive surgery, tumor-bed radiation therapy, and mitotane treatment. A year later, a large lymph-node metastasis was surgically removed from the lower abdomen and mitotane treatment was again started postoperatively. The patient is now scheduled for polychemotherapy because of progressive metastatic disease revealed by follow-up CT and FDG-PET scanning in June 2006.