title: Repeated resections for liver metastasis from primary adrenocortical carcinoma: A case report.
abstract: BACKGROUND
  Adrenal cortical carcinoma (ACC) is a very rare type of tumor that generally has a poor prognosis. Little has been reported on repeated liver resections with recurrent metastasis still confined to the liver. In this report, we describe a case of functioning ACC in a 65-year-old woman with 2 liver metastases of the ACC (at 1.5 and 4 years) after the right adrenalectomy.
  
  
  METHODS
  A 65-year-old woman was referred to our hospital based on a suspicion of hyperaldosteronism. Abdominal computed tomography revealed a lesion at the right adrenal gland; therefore, we performed right adrenalectomy and subsequently diagnosed the lesion as ACC. However, follow-up computed tomography at 1.5 and 4 years after the right adrenalectomy revealed liver metastasis of ACC; liver resection was performed for both metastases.
  
  
  CONCLUSIONS
  Complete surgical resection is the established approach for the treatment of ACC. The prognosis of ACC is usually dismal, and recurrence rates of up to 85% have been reported. However, the appropriate treatment for recurrent ACC is not well established, and the effectiveness of other modalities, such as chemotherapy and radiotherapy, is not proven. Therefore, surgical resection may currently be the most appropriate treatment modality, as the patient achieved a disease-free interval of 2.5 years after the first liver resection.
  
  
  CONCLUSIONS
  In selected patients with recurrent or metastatic ACC, resection is likely to be associated with prolonged survival. However, a full cure is generally not achievable, and a multidisciplinary approach is likely needed to achieve long-term disease-free status and survival.
authors.affiliation: Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan. Electronic address: r_so18@yahoo.co.jp.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Nakano
authors.affiliation: Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Satoh
authors.affiliation: Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors.forename: Hirochika
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Yoshimura
authors.affiliation: Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Miyoshi
authors.affiliation: Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Matsukawa
authors.affiliation: Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Shiozaki
authors.affiliation: Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Ichimura
authors.affiliation: Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors.forename: Masazumi
authors.initials: M
authors.lastname: Okajima
authors.affiliation: Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors.forename: Motoki
authors.initials: M
authors.lastname: Ninomiya
keywords: Adrenal cortical carcinoma; Liver metastasis; Resection