Adrenocortical carcinoma mimicking lung cancer and responding to vinorelbine/carboplatin and pemetrexed/carboplatin.
Adrenocortical carcinoma is an aggressive cancer, with an incidence of 0.5-2 per million. We present a case of adrenocortical carcinoma with all the clinical and partly immunohistochemical features of disseminated undifferentiated lung cancer, and 'accidentally' treated as such. Four cycles of carboplatin-vinorelbine conferred partial response in the adrenal, lung and disappearance of a 2 cm subcutaneous iliac nodule that had appeared suddenly before the first course. Owing to progression, four cycles of carboplatin-pemetrexed were administered inducing partial response and then stable disease for an additional 12 months. As fluoro-d-glucose (FDG)-positron emission tomography (PET) only showed activity in the adrenal, laparoscopic adrenalectomy was performed. Three months later FDG-PET revealed a lung nodule unresponsive to carboplatin-pemetrexed, removed by wedge resection. Finally, re-evaluation by a tertiary centre confirmed adrenocortical carcinoma with Ki67-50% in the adrenal and the lung. The patient is alive and tumour free almost 3.5 years after retrospective diagnosis of metastatic adrenocortical cancer.
Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway Cancer Clinic, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway Department of Oncology, Aalborg University Hospital, Aalborg, Denmark.
Oluf Dimitri
OD
Røe
Department of Internal Medicine, Levanger Hospital, Levanger, Norway.
Per Arne
PA
Oppegaard
Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
Mona-Elisabeth
ME
Revheim
Department of Pathology, Oslo University Hospital, Oslo, Norway.
Aud
A
Svindland
D000306:Adrenal Cortex Neoplasms / Q000188:drug therapy / Q000473:pathology; D018268:Adrenocortical Carcinoma / Q000175:diagnosis / Q000188:drug therapy* / Q000556:secondary*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D003951:Diagnostic Errors; D005260:Female; D005971:Glutamates / Q000008:administration & dosage; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D008875:Middle Aged; D000068437:Pemetrexed; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine
D005971:Glutamates; D000068437:Pemetrexed; D014747:Vinblastine; D006147:Guanine; D016190:Carboplatin; D000077235:Vinorelbine