Publicado

2019-07-01

Late recurrence of adrenocortical carcinoma and metastatic disease. Case report

Recurrencia tardía de carcinoma adrenocortical con compromiso metastásico. Reporte de un caso

Palabras clave:

Adrenocortical Carcinoma, Adrenal Cortex Neoplasms, Adrenal Gland Neoplasms (en)
Neoplasias de la corteza suprarrenal, Enfermedades de la corteza suprarrenal, Glándulas suprarrenales (es)

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Autores/as

  • Maria Alejandra Pérez-Ardila Fundación Cardioinfantil - Cardiology Institute - Department of Internal Medicine
  • Julián Naranjo-Millán Fundación Cardioinfantil - Cardiology Institute - Department of Internal Medicine
  • Helman Giral Fundación Cardioinfantil - Cardiology Institute - Department of Internal Medicine
  • Jacqueline Mugnier Fundación Cardioinfantil - Cardiology Institute - Department of Pathology
  • Henry Altamar Fundación Cardioinfantil - Cardiology Institute - Department of Endocrinology

Introduction: Adrenocortical carcinoma (ACC) is a malignancy with an annual incidence of 0.72 cases per million people. It is a rare tumor that is associated with high mortality in late stages, as well as with a 5-year survival of 13% in stage IV patients, and 61% in stage II lesions. Nevertheless, tumor recurrence occurs in up to 54% at 23 months with predominance of locoregional involvement, being striking the late presentation of tumor recurrence with extensive involvement.

Case presentation: This is the case of a 52-year-old male patient with a history of resection of an ACC of 6cm five years earlier, who was admitted for decompensated heart failure. A chest x-ray was taken suggesting metastasis. After conducting biochemical studies and CT scan of the abdomen, ACC with metastases to liver and lung was diagnosed. The patient decided not to receive palliative chemotherapy.

Conclusion: This unfortunate outcome is related to the lack of follow-up after the initial procedure. Clinical, hormonal, and imaging evaluation is recommended every 3 months for 2 years, and then at least every 6 months.

Introducción. El carcinoma adrenocortical (CAC) es una neoplasia que reporta incidencia anual de 0.72 casos por cada millón de personas. Se trata de un tumor infrecuente que se asocia con una mortalidad elevada en estadios avanzados y una supervivencia a 5 años del 13% de pacientes en estadio IV y del 61% para lesiones en estadio II; sin embargo, la presencia de recurrencia tumoral es hasta de 54% a los 23 meses con predominio de compromiso locoregional, siendo llamativa la presentación tardía de la recurrencia tumoral con compromiso extenso.

Presentación del caso. Paciente masculino de 52 años con antecedente de resección de un CAC de 6cm de tamaño 5 años atrás, quien ingresa por falla cardíaca descompensada, encontrando en la radiografía de tórax una imagen sugestiva de metástasis. Tras estudios bioquímicos y tomografía de abdomen se diagnostica CAC con compromiso metastásico a hígado y pulmón. El paciente opta por no recibir manejo quimioterapéutico paliativo.

Conclusión. Este desenlace desafortunado tiene relación con la ausencia de seguimiento tras el procedimiento inicial. Se recomienda evaluación clínica, hormonal e imagenológica cada 3 meses por 2 años y luego al menos cada 6 meses.

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Esta obra está bajo una licencia Creative Commons Reconocimiento 3.0 Unported.

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