title: Mixed corticomedullary adrenal carcinoma - case report: Comparison in features, treatment and prognosis with the other two reported cases.
abstract: BACKGROUND
  Adrenal corticomedullary adenoma was reviewed in many cases in PubMed Library, While the coincidence corticomedullary adrenal carcinoma in the same gland was just described in two cases in the medical literature. Our case is the third to be reported and was treated with surgery and adjuvant chemotherapy and followed for two years.
  
  
  METHODS
  A 50-year-old man suffered from a mass effect in the left abdominal side. While the laboratory showed a mild elevation in the levels of both serum cortisol and 24h urine cortisol, radiological images were highly suggested an adrenal malignant tumor without metastasis. At surgery a 22cm sized mass was completely resected. Immunohistochemical study identified expression of both adrenocortical carcinoma and pheochromocytoma markers.
  
  
  CONCLUSIONS
  Cases of coincidence corticomedullary tumor have been published in many reviews, cortical and/or medulllary hypersecretion were not always detected preoperatively by biochemical tests. Mixed corticomedullary carcinoma are exceedingly rare, we came across three reported cases in medical literature, in one case laboratory tests confirmed both cortical and medulla hypersecretion, while the two others detected only cortical hypersecretion. The final diagnosis was always confirmed by immunohistochemical staining.
  
  
  CONCLUSIONS
  It could be noted that this is the first comparison of presentation, diagnosis, treatments and follow-up of the three cases of Mixed corticomedullary carcinoma. This could contribute to understanding the behavior and management of this rare malignancy and make it more familiar in clinical practice.
authors.affiliation: General Surgery Department, Damascus Hospital, Syrian Private University, P.O. Box: 10989, Syria. Electronic address: drsabekb@gmail.com.
authors.forename: Mhd Belal
authors.initials: MB
authors.lastname: Alsabek
authors.affiliation: General Surgery Department, Damascus Hospital, P.O. Box: 8085, Damascus, Syria. Electronic address: ralhmaidi@yahoo.fr.
authors.forename: Riad
authors.initials: R
authors.lastname: Alhmaidi
authors.affiliation: American Board of Pathology, Amana Pathology Laboratory, Mazra'a St., Damascus, Syria. Electronic address: ghazzawib@yahoo.com.
authors.forename: Bader
authors.initials: B
authors.lastname: Ghazzawi
authors.affiliation: American Board of Pathology, Amana Pathology Laboratory, Mazra'a St., Damascus, Syria. Electronic address: dr_hamed@yahoo.com.
authors.forename: Ghiath
authors.initials: G
authors.lastname: Hamed
authors.affiliation: Alberoni Hospital, Damascus University Faculty of Medicine, P.O. Box: 60527, Damascus, Syria. Electronic address: alhadialseoudi@gmail.com.
authors.forename: Alhadi
authors.initials: A
authors.lastname: Alseoudi
keywords: Coexistence corticomedullary carcinoma; Coincidence corticomedullary carcinoma; Corticomedullary adenoma; Mixed corticomedullary carcinoma