A Case Report of Bilateral Sarcomatoid Carcinoma of Adrenal Glands With Adrenal Insufficiency

Abstract

Adrenocortical carcinomas are relatively rare, but they are considered to be highly aggressive malignant tumors. Sarcomatoid carcinomas represent an even more aggressive type. Bilateral malignant adrenal tumors are extraordinary rare, except for those that represent metastatic spread from a primary neoplasm. Here we report a case of a 69-year-old woman who presented symptoms that raised strong suspicions of adrenal insufficiency. Bilateral adrenal masses, identified in the imaging study, were responsible for the clinical manifestation and surgically resected. Surgical specimens of the bilateral adrenal tumors shared histological features compatible with sarcomatoid carcinoma. It was very difficult to confirm that the sarcomatoid carcinomas were derived from the cortex of the adrenal glands, but careful morphological observation and the panel of antibodies used for immunohistochemistry made the diagnosis possible. This is the first report of sarcomatoid carcinomas involving both adrenal glands. It should be emphasized that sarcomatoid carcinoma can arise bilaterally from even functionally impaired adrenal glands.

A Case Report of Bilateral Adrenal Sarcomatoid Carcinoma

“…Three of the reported cases were metastatic to liver [11], inferior vena cava [12], and lung [13]. One patient had bilateral adrenal sarcomatoid carcinoma [4]. Our patient had bilateral adrenal sarcomatoid carcinoma and liver metastasis at the time of diagnosis.…”

“…However the diagnosis is much more complicated especially when the differentiation is indistinctive and when tumors present bilaterally and immunostaining should be employed [4]. Positivity with calretinin and/or α -inhibin is known to be of highly diagnostic value for adrenocortical carcinoma [15], although all of these immunohistochemical markers were negative in the present case.…”

“…Sarcomatoid carcinoma is a biphasic tumor with sarcoma like or sarcomatoid component and has a poor prognosis with rapid fatal behavior. Adrenal sarcomatoid carcinoma is a very rare malignant tumor and to date there are only 19 cases reported in the literature and to the best of our knowledge there has been only one case with bilateral disease [4]. …”

Adrenocortical sarcomatoid carcinoma: a case report and review of the literature

“…Adrenal sarcomatoid carcinomas (ASC) are rare aggressive malignant neoplasms of the adrenal gland, showing both carcinomatous and mesenchymal differentiation [ 1 ]. It has a poor prognosis as most of patients have distant metastasis at the time of diagnosis [ 2 ].…”

A Case Report of Late Local Relapse of Adrenocortical Carcinoma 18 Years After Adrenalectomy

“…The median survival is about 2 years [11]. ACC is a very rare malignant tumor and to date there were only 20 cases reported in the lite rature and to the best of our knowledge there have been no cases with the diseasefree survival more than 5 years [9,10,12,18]. The majority of those pa tients succumbed to disease within a year due to local recurrence or metastases [20].…”