Adrenocortical carcinoma: An extremely uncommon entity and the role of Immunohistochemistry in its diagnosis
A gentleman aged 60 years presented with a moderate pain abdomen for 5 months and backache radiating to the hypochondrium for 1 month. He had nausea, low appetite, and mild weight loss (1.5 kg) during that period. He was treated for gastritis off and on with antacid, H2 blockers and proton pump inhibitors without significant relief of symptoms before coming to our center. On examination, a tender mass was palpable over left hypochondrium, left lumber region, and epigastrium crossing the midline. The central nervous system, cardio-vascular, and respiratory systems were clinically normal. He also did not have externally palpable lymphadenopathy in the cervical, supraclavicular and inguinal region. His complete blood count showed moderate anemia (hemoglobin 9.8 g/dL) and rather high erythrocyte sedimentation rate (135 mm at 1sth). Biochemical investigations showed venous plasma glucose, urea and creatinin electrolytes within biological reference range. Urinary VMA for 24 h was 2.60 mg/g creatinin (normal 1.8-6.7). On ultrasonography a solid, heterogeneous mass with central hypoechoic area measuring 14 × 13.1 cm seen in the left supra renal area. CECT abdomen revealed a heterogeneous well defined mass lesion with central necrosis measuring 15 × 10.3 × 13 cm in left suprarenal region medially extending upto the midline, and displacing or pressing on the nearby viscera in all directions. Radiological possibilites were two, namely: (i) ACC (left) infiltrating upper pole of left kidney and, (ii) RCC arising from upper pole of left kidney involving adrenal gland. The patient underwent left adrenelectomy and radical nephrectomy.