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Recurrent adrenocortical carcinoma after laparoscopic resection

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 191–195 (2007)Cite this article

Abstract

Background A 53-year-old man presented with left-sided flank pains to the Gastroenterology department of our clinic in September 2004. A left adrenal mass of 6.5 cm by 7.5 cm was detected by a CT scan. The patient showed no evidence of Cushing's syndrome, and had normal blood pressure and potassium levels. Endocrine tests ruled out excess levels of aldosterone or catecholamines. The patient underwent laparoscopic surgery to remove the tumor mass; histologic work-up revealed an adrenocortical carcinoma. A fluorodeoxyglucose (FDG)-PET scan 1 month, and a CT scan 8 months postoperatively showed no pathologic findings. The patient, however, again presented with left-sided flank pain to our Endocrinology department in August 2005.

Investigations In our department, laboratory work-up for endocrine activity was performed, as well as CT scans of the adrenal region, and FDG-PET scans in order to determine the extension of disease. Histologic work-up of the removed tumor tissue was performed.

Diagnosis Recurrent adrenocortical carcinoma after laparoscopic adrenalectomy.

Management In our department, 10 months after initial laparoscopic surgery, local tumor recurrence was treated by repeated extensive surgery, tumor-bed radiation therapy, and mitotane treatment. A year later, a large lymph-node metastasis was surgically removed from the lower abdomen and mitotane treatment was again started postoperatively. The patient is now scheduled for polychemotherapy because of progressive metastatic disease revealed by follow-up CT and FDG-PET scanning in June 2006.

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Figure 1: CT and fluorodeoxyglucose (FDG)-PET scans of the tumor before and after primary surgery in the patient described.
Figure 2: CT and fluorodeoxyglucose (FDG)-PET scans from 2006 after resection of recurrent tumor.

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Authors and Affiliations

  1. A Schlamp is a Medical Resident in and M Reincke is a Director of Medizinische Klinik Innenstadt, K Hallfeldt is a Professor for Endocrine and Visceral Surgery at Chirurgische Klinik Innenstadt, University Hospital, Munich.,

    Angelika Schlamp, Klaus Hallfeldt & Martin Reincke

  2. and the Section Chief of Body Imaging in the Department of Clinical Radiology, T Pfluger is an Associate Professor and Consultant in Nuclear Medicine and Radiology in the Department of Nuclear Medicine, U Mueller-Lisse is an Associate Professor of Radiology, an Attending Radiologist, University of Munich, Munich, Germany,

    Ullrich Mueller-Lisse & Thomas Pfluger

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  1. Angelika Schlamp
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Correspondence to Angelika Schlamp.

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Schlamp, A., Hallfeldt, K., Mueller-Lisse, U. et al. Recurrent adrenocortical carcinoma after laparoscopic resection. Nat Rev Endocrinol 3, 191–195 (2007). https://doi.org/10.1038/ncpendmet0391

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