title: Peritoneal carcinosis in apparently benign cortisol producing adrenal adenoma ≥ 5 cm in diameter: the need of regular postoperative surveillance.
abstract: BACKGROUND
  Clinical and histopathological distinction between benign and malignant adrenocortical tumors can be a challenge.Report on 2 patients with cortisol producing apparently benign adrenal adenomas ≥ 5 cm in diameter with local malignant recurrence and peritoneal carcinomatosis after endoscopic surgery.
  
  
  RESULTS
  Case 1: The 59-year-old male presented with adrenal hypercortisolism due to a 5.0 cm large adrenal tumor on the left side. A retroperitoneoscopic total adrenalectomy was performed. Histologically, a benign adrenal adenoma (Weiss score 1, Ki-67 < 2%) was found. 6 months later, the patient developed clinically and biochemically recurrent disease with recurrent tumor in the left adrenal region and peritoneal carcinomatosis. The patient died 5 months after second surgery. Case 2: The 32-year-old female was pregnant in 27th week when presenting with adrenal hypercortisolism due to a 5.5 cm large adrenal tumor on the left side. She was operated on using a laparoscopic approach and a total adrenalectomy was carried out. Histological examination revealed a benign adrenocortical adenoma (Weiss score 1, Ki-67 < 5%). 4 years later, the patient came back with clinically and biochemically recurrent disease. Imaging showed a 10 cm large tumor in the left retroperitoneum and a diffuse peritoneal carcinomatosis. The patient died 2 months after diagnosis.
  
  
  CONCLUSIONS
  Cortisol producing adrenal tumors ≥ 5 cm in diameter are at risk to be misdiagnosed as apparently benign. Regular surveillance should be considered in patients presenting with large cortisol producing tumors.
authors.affiliation: Department of Surgery, Haukeland University Hospital, Bergen, Norway. michael.brauckhoff @kir.uib.no
authors.forename: M
authors.initials: M
authors.lastname: Brauckhoff
authors.forename: J E
authors.initials: JE
authors.lastname: Varhaug
authors.forename: S
authors.initials: S
authors.lastname: Hauptmann
authors.forename: L A
authors.initials: LA
authors.lastname: Akslen
authors.forename: P N
authors.initials: PN
authors.lastname: Thanh
authors.forename: A
authors.initials: A
authors.lastname: Viste
authors.forename: A
authors.initials: A
authors.lastname: Heie
authors.forename: H
authors.initials: H
authors.lastname: Dralle
mesh_terms: D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D003480:Cushing Syndrome / Q000209:etiology*; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D047368:Tumor Burden
chemical_list: D006854:Hydrocortisone