A case of adrenocortical carcinoma associated with recurrence after laparoscopic surgery

Laparoscopic adrenalectomy has become increasingly popular because of its m inimally invasive nature, but guidelines for selection of cases suitable fo r this surgical procedure have not been established. We report a 52-year-ol d woman with adrenocortical carcinoma, manifesting as Gushing's syndrome, t reated with laparoscopic adrenalectomy. The tumour was removed in toto and had been histologically diagnosed as adrenocortical adenoma, However, the p atient developed intra-abdominal peritoneal dissemination of carcinoma 15 m onths after surgery. Review of the histopathological findings of the resect ed adrenocortical tumour revealed that the neoplasm met five out of nine hi stological criteria for adrenocortical malignancy, and was diagnosed as adr enocortical carcinoma. Histopathological examination of the tumour was also consistent with adrenocortical carcinoma. The patient responded extremely well to chemotherapy, including carboplatin, etoposide and o,p'-DDD (1,1-di chlorodiphenyldichloroethane), and a subsequent CT (computed tomography) sc an 12 months after the start of chemotherapy demonstrated no evidence of di sease. However, the patient developed neurological impairment, including dy sarthria, as a side-effect of o,p'-DDD, The patient died of aspiration pneu monia due to a decreased pharyngeal reflex. Postmortem examination revealed no foci of residual carcinoma. This case report emphasizes the importance of excluing possible adrenocortical malignancy in patients considered for l aparoscopic adrenalectomy, histopathological diagnosis of adrenocortical ma lignancy and careful monitoring for neurotoxicity during o,p'-DDD treatment .