No abstract

Adrenocortical carcinoma is a rare cancer. Oncocytic tumors of the adrenal gland are rarer. Most Oncocytic Adrenal Neoplasms are benign and carry favourable prognosis. They are classified as oncocytoma, oncocytic neoplasm of uncertain malignant potential and oncocytic adrenal carcinoma. The malignant nature of oncocytic neoplasm of adrenal gland can only be confirmed on histopathology. We report a case of a 55-year-old male with newly diagnosed hypertension being evaluated for left adrenal mass concerning for adrenocortical carcinoma. Open radical left adrenalectomy and nephrectomy was done and histopathology confirmed oncocytic variant of adrenocortical carcinoma based on Lin-Weiss-Bisceglia scoring system which has been developed particularly for oncocytic type of tumor. Though rare, oncocytic neoplasm has to be considered as one of the differential diagnoses of adrenocortical mass, especially those presenting as a large mass because malignant oncocytic neoplasm of adrenal gland as large as 23cm have been reported. Imaging modalities like ultrasonography, computed tomography or magnetic resonance imaging, though useful in evaluating an adrenocortical mass, cannot predict malignant nature of an oncocytic neoplasm. Diagnosis of adrenocortical carcinoma is therefore reliably made only after histopathological examination of the surgical specimen. Surgical resection in those presenting with nonmetastatic resectable disease remains the mainstay of ACC treatment. Oncocytic ACC compared with conventional ACCs matched for age, gender, disease stage and status of surgical resection, shows significant better overall survival thus representing more indolent variant of an aggressive and often fatal disease.

Introduction: Postoperative pain remains a significant problem in patients undergoing abdominal surgeries, and has a profound effect on patient recovery. High-dose opioids hamper bowel motility and increase nausea and vomiting. Intravenous lidocaine has been used as part of a multimodal analgesia protocol for providing effective pain relief and attenuating surgery-associated inflammatory response. Preoperative pregabalin also has a beneficial effect in reducing pain. This study was carried out to assess the efficacy of combining these drugs in reducing pain, paralytic ileus, and stress response. Method: Patients undergoing elective laparotomy were randomized into two groups. Group A patients received preoperative placebo and intraoperative lidocaine infusion. Group B patients received preoperative pregabalin and lidocaine. The pain was assessed using a visual analog scale at 2, 6, 18, and 24 hours postoperatively. Morphine consumption on a patient-controlled analgesia pump was also noted. Surgical stress response was assessed by measuring perioperative total leucocyte count, interleukin-6, and C-reactive protein. Result: Postoperative pain scores at 6, 18, and 24 hours were significantly lower in Group B patients who had received pregabalin. These patients also had lower morphine consumption and earlier bowel recovery as measured by the first passage of stools. Perioperative inflammatory markers were similar in both groups. Conclusion: Preoperative pregabalin when used with intravenous lidocaine has a synergistic effect on reducing postoperative pain and opioid consumption. This also has a beneficial effect on the return of bowel function.