title: Brain metastasis in patients with adrenocortical carcinoma: a clinical series.
abstract: BACKGROUND
  Adrenocortical carcinoma (ACC) is a heterogeneous and rare disease. At presentation or at the time of a recurrence, the disease commonly spreads to the liver, lungs, lymph nodes, and bones. The brain has only rarely been reported as a site of metastases.
  
  
  OBJECTIVE
  The aims of this report were to describe the clinical characteristics of patients with ACC who developed brain metastasis and were evaluated at the National Cancer Institute.
  
  
  METHODS
  We describe the history and clinical presentation of six patients with ACC and metastatic disease in the brain. Images of the six patients and pathology slides were reviewed when available.
  
  
  RESULTS
  The median age at the time of the diagnosis of ACC was 42 years. The median time from the initial diagnosis until the presentation of brain metastasis was 43 months. As a group the patients had previously received multiples lines of chemotherapy (median of three), and they presented with one to three metastatic brain lesions. Four patients underwent metastasectomy, one had radiosurgery, and one had both modalities. Two patients are still alive, three died, between 2 and 14 months after the diagnosis of brain metastases, and one was lost to follow-up.
  
  
  CONCLUSIONS
  Patients with advanced ACC can rarely present with metastasis to the brain, most often long after the initial diagnosis. Timely diagnosis of brain metastasis with appropriate intervention after discussion in a multidisciplinary meeting can improve the prognosis in this particular scenario.
authors.affiliation: Center for Cancer Research (M.B., N.T., M.V., M.E., T.F.) and National Laboratory of Pathology (A.R., M.Q.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892; and The George Washington University (S.M.), Rockville, Maryland 20852.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Burotto
authors.forename: Nishant
authors.initials: N
authors.lastname: Tageja
authors.forename: Avi
authors.initials: A
authors.lastname: Rosenberg
authors.forename: Sowmya
authors.initials: S
authors.lastname: Mahalingam
authors.forename: Martha
authors.initials: M
authors.lastname: Quezado
authors.forename: Margarita
authors.initials: M
authors.lastname: Velarde
authors.forename: Maureen
authors.initials: M
authors.lastname: Edgerly
authors.forename: Tito
authors.initials: T
authors.lastname: Fojo
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D018268:Adrenocortical Carcinoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D000328:Adult; D001921:Brain / Q000473:pathology / Q000601:surgery; D001932:Brain Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis