title: Giant nonfunctioning adrenocortical carcinoma: a case report and review of the literature.
abstract: BACKGROUND
  Adrenocortical carcinoma is a rare and aggressive malignancy. Patients usually present early with manifestation of abnormal hormone secretion. However, adrenocortical carcinoma can also be nonfunctioning, and such patients present late with a mass effect or distant metastases.
  
  
  METHODS
  We herein report a case of a 30-year-old Sri-Lankan woman who presented with a 3-month history of left flank pain associated with nausea, vomiting, and weight loss. Imaging revealed a large left upper quadrant mass with a 1.8-cm left lung nodule. The differential diagnoses included a left adrenal mass, left upper pole renal mass, and retroperitoneal sarcoma. A functional adrenal work-up revealed no abnormal findings. Surgical excision of the mass was uneventful with no postoperative complications. Pathological analysis revealed a nonfunctioning adrenocortical carcinoma measuring 16 × 14 × 10 cm. To our knowledge, a mass of this size is among the largest nonfunctioning adrenocortical carcinomas reported in the published literature. The investigations and approach to treatment were consistent with those in the published literature.
  
  
  CONCLUSIONS
  Large nonfunctioning adrenocortical carcinomas pose a diagnostic and therapeutic challenge, and most are diagnosed at a late stage. Appropriate imaging and functional work-up of the mass are vital before treatment. Surgical excision is safe, even for large adrenocortical carcinomas; excision in patients with advanced disease has been shown to have the best outcomes.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Almarzouq
authors.forename: Sami
authors.initials: S
authors.lastname: Asfar
authors.forename: Sundus
authors.initials: S
authors.lastname: Hussain
authors.forename: Adel
authors.initials: A
authors.lastname: Al-Hunayan
authors.affiliation: Urology Unit, Department of Surgery, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Kuwait. saad.aldousari@gmail.com.
authors.forename: Saad
authors.initials: S
authors.lastname: Aldousari
mesh_terms: D000304:Adrenal Cortex Function Tests; D000306:Adrenal Cortex Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D000315:Adrenalectomy; D018268:Adrenocortical Carcinoma / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor