[P-20] Adrenocortical carcinoma

Farah Farera¹, Sri Suryanti¹ and Jumadi Santoso²

1. Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital Bandung, Indonesia
2. Surgical Department, Dr Soekardjo Hospital, Tasikmalaya, Indonesia

Background: Adrenocortical carcinoma (ACC) is a malignant neoplasm of adrenal cortex with annual incidence of 0.6 – 1.67 cases per million population per year.

Case Presentation: We reported a 68-year-old male with right waist pain, palpable solid mass in right flank and urinating spontaneously. Abdominal ultrasound showed a solid mass of right adrenal gland and cysts in both kidneys. Hepatobiliary tract, pancreas, spleen and urinary bladder were within normal limits. Neither ascites nor enlarged prostate gland were present. Exploratory laparatomy and right adrenalectomy were performed. On gross inspection, a brownish white soft friable mass measured 10 x 7 x 5 cm. On histopathological examination, the tumour consisted of solidify hyperplastic round to oval cells having pleomorphic and hyperchromatic nuclei, prominent nucleoli and atypical mitosis. There was necrotic area. The tumour had invaded the capsule and lymphovascular vessels. Immunoreactivities were positive for synaptophysin and negative for chromogranin, PAX8 and S100. It was concluded as adrenocortical carcinoma.

Discussion and Conclusion: ACC is malignant epithelial tumour of adrenal cortical cells. It represents ≥ 3 of Weiss criteria, including > 5 mitoses per 50 HPFs, atypical mitosis, high nuclear grade, diffuse architecture, < 25% clear cells and invasion of venous structure/sinusoidal structure/capsule. ACC is a rare case of endocrine malignancy with poor prognosis. Early diagnosis and removal of the tumour has higher survival rate.