Laparoscopic Right Adrenalectomy in a Large Right Adrenal Oncocytic Carcinoma

Abstract

Background. Adrenocortical carcinomas are rare and aggressive tumors. The recently described oncocytic subtype has been reported approximately 40 times in the literature. 1 In this video, we describe an unusual case of a large adrenal oncocytic carcinoma, its minimally invasive approach, and its anatomopathological features. Case description. A 43-year-old male presented to the emergency room with acute abdominal pain and fever. Blood tests showed 20,000 white blood cells and a reactive C-protein of 25. Tomography showed a large right adrenal tumor with necrosis. Antibiotics were started at the intensive care unit. A complete study showed normal tests, including hormones, cortisol, and metanephrines. At the multidisciplinary team meeting it was decided to perform a right transabdominal laparoscopic adrenalectomy. The tumor was approached from the medial side to the lateral side, always controlling the inferior vena cava. Indocyanine green was used to identify vascular structures. Anatomical pathology revealed a 15 cm lesion corresponding to a malignant adrenal oncocytic carcinoma

Oncocytic adrenocortical tumour presenting as an incidentaloma: a diagnostic challenge

“…Whether this is to be carried out via an open or laparoscopic approach remains controversial 13. Laparoscopic removal of large (up to 15 cm) oncocytic ACCs has been described 17 25. A 6-monthly CT or MRI for 2–3 years postoperatively and then annually for a total of 5 years has been proposed by Kanitra et al 13.…”