Adrenocortical cancer: late diagnosis of the disease on the example of a clinical case. Case report

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Abstract

Adrenocortical carcinoma (ACC) is a rare malignant tumor originating in the adrenal cortex and characterized by poor 5-year survival. It occurs with a frequency of 2–4 cases per 2 million in the population. Women are more frequently affected than men and it is mostly detected in the fourth and fifth decades. In the most of cases, the cancerogenesis occurs sporadically because of gene driver mutations in somatic adrenocortical cells, in other cases it can be found as part of a genetically determined syndrome such as Li–Fraumeni syndrome or Wermer's syndrome (multiple endocrine adenomatosis type I). ACC most frequently happens occurs without symptoms in the initial stages leading to poor diagnoses. Because of this lack of early detection, the tumor is not considered malignant reducing the benefits of further treatment. Sometimes the fact that the resected tumor is indeed adrenocortical carcinoma becomes clear only after recurrence, or after the appearance of metastases. We present a case of adrenocortical carcinoma in a 46-year-old woman who went to the doctor in 1.5 year after symptoms were manfested. This clinical case illustrates the consequences of late diagnosis of a malignant tumor. We would like to emphasize the importance of timely detection of a neoplasm, using all of the potential of laboratory-instrumental and genomic analysis. Due to low oncological awareness, our patient was slow to seek medical help, which in turn led not only to metastases, but also to complications in the cardiovascular system.

About the authors

Evgenia A. Starostina

Endocrinology Research Centre

Author for correspondence.
Email: colpakova.ev@mail.ru
ORCID iD: 0000-0003-2283-8958

врач-эндокринолог, сотр. Координационного совета ФГБУ «НМИЦ эндокринологии»

Russian Federation, Moscow

Natalya V. Molashenko

Endocrinology Research Centre

Email: colpakova.ev@mail.ru
ORCID iD: 0000-0001-6265-1210

канд. мед. наук, вед. науч. сотр. 

Russian Federation, Moscow

Anna R. Levshina

Sechenov First Moscow State Medical University (Sechenov University)

Email: colpakova.ev@mail.ru
ORCID iD: 0000-0002-9315-3801

студентка 

Russian Federation, Moscow

Nano V. Pachuashvili

Endocrinology Research Centre; Sechenov First Moscow State Medical University (Sechenov University)

Email: colpakova.ev@mail.ru
ORCID iD: 0000-0002-8136-0117

мл. науч. сотр. лаб. эндокринной биофотоники ФГБУ «НМИЦ эндокринологии»; ординатор Института клинической морфологии и цифровой патологии ФГАОУ ВО «Первый МГМУ им. И. М. Сеченова» (Сеченовский Университет)

Russian Federation, Moscow; Moscow

Anastassia Chevais

Endocrinology Research Centre

Email: colpakova.ev@mail.ru
ORCID iD: 0000-0001-5592-4794

аспирант 

Russian Federation, Moscow

Mariya P. Isaeva

Endocrinology Research Centre

Email: colpakova.ev@mail.ru
ORCID iD: 0000-0002-9963-6783

аспирант 

Russian Federation, Moscow

Kantemir V. Getazheev

Pirogov Russian National Research Medical University

Email: colpakova.ev@mail.ru
ORCID iD: 0000-0001-5193-0556

клин. ординатор 

Russian Federation, Moscow

Dmitry G. Beltsevich

Endocrinology Research Centre

Email: colpakova.ev@mail.ru
ORCID iD: 0000-0001-7098-4584

д-р мед. наук, проф., гл. науч. сотр. отд. хирургии 

Russian Federation, Moscow

Nadezhda M. Platonova

Endocrinology Research Centre

Email: colpakova.ev@mail.ru
ORCID iD: 0000-0001-6388-1544

д-р мед. наук, проф., зав. отд. терапевтической эндокринологии

Russian Federation, Moscow

Ekaterina A. Troshina

Endocrinology Research Centre

Email: colpakova.ev@mail.ru
ORCID iD: 0000-0002-8520-8702

чл.-кор. РАН, д-р мед. наук, проф., зам. дир. – дир. Института клинической эндокринологии 

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Clinical signs of adrenocortical cancer.

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3. Fig. 2. The patient's appearance in the postoperative period.

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4. Fig. 3. Multispiral computed tomography data (October 3, 2019).

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