Abstract
Background:
Clinical and histopathological distinction between benign and malignant adrenocortical
tumors can be a challenge.
Methods:
Report on 2 patients with cortisol producing apparently benign adrenal adenomas≥5 cm
in diameter with local malignant recurrence and peritoneal carcinomatosis after endoscopic
surgery.
Results:
Case 1: The 59-year-old male presented with adrenal hypercortisolism due to a 5.0 cm
large adrenal tumor on the left side. A retroperitoneoscopic total adrenalectomy was
performed. Histologically, a benign adrenal adenoma (Weiss score 1, Ki-67<2%) was
found. 6 months later, the patient developed clinically and biochemically recurrent
disease with recurrent tumor in the left adrenal region and peritoneal carcinomatosis.
The patient died 5 months after second surgery.
Case 2: The 32-year-old female was pregnant in 27th week when presenting with adrenal hypercortisolism due to a 5.5 cm large adrenal
tumor on the left side. She was operated on using a laparoscopic approach and a total
adrenalectomy was carried out. Histological examination revealed a benign adrenocortical
adenoma (Weiss score 1, Ki-67<5%). 4 years later, the patient came back with clinically
and biochemically recurrent disease. Imaging showed a 10 cm large tumor in the left
retroperitoneum and a diffuse peritoneal carcinomatosis. The patient died 2 months
after diagnosis.
Conclusion:
Cortisol producing adrenal tumors≥5 cm in diameter are at risk to be misdiagnosed
as apparently benign. Regular surveillance should be considered in patients presenting
with large cortisol producing tumors.
Key words
adrenal cushing disease - malignant recurrence - postoperative surveillance
