Hantson Philippe, Hubert Catherine, Dieu Audrey, Castanares-Zapatero Diego, Lelotte Julie, Laterre Pierre-François
Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, 1200 Brussels, Belgium; Louvain Centre for Toxicology and Applied Pharmacology (LTAP), Université catholique de Louvain, 1200 Brussels, Belgium.
Department of Abdominal Surgery and Transplantation, Unit of Hepato-biliary and Pancreatic Surgery, Cliniques St-Luc, Université catholique de Louvain, 1200 Brussels, Belgium.
Int J Surg Case Rep. 2020;73:109-111. doi: 10.1016/j.ijscr.2020.06.101. Epub 2020 Jul 10.
Adrenocortical carcinoma is a rare type of malignant adrenal tumor with a possibility of delayed metastases. Diagnosis may be delayed with a non-secreting tumor or metastasis, and even in this case, surgical management may be complicate.
A 55-year-old man underwent elective surgery for the resection of a large intra-hepatic mass from an undetermined type according to a recent liver biopsy. He had a previous history of a non-secreting adrenal tumor that was operated ten years before. Pre-operatively, he was poorly symptomatic, with a normal arterial blood pressure. Anesthesia induction was uneventful, but at the time of tumor resection and removal, he developed extreme vasoplegia and shock with anuric renal failure, lactic acidosis, four-limb and abdominal compartment syndrome. The patient died on day 9 from delayed septic complications. According to the pathological findings, the tumor was a non-secreting adrenocortical carcinoma.
Adrenocortical carcinoma (ACC) is rare condition with diverse clinical manifestations due to excessive hormonal production when the tumor is secreting and mimicking pheochromocytoma. Our patient underwent the resection a large intrahepatic non-secreting metastasis more than ten years after the initial lesion. Peri-operative and post-operative management was complicated by a refractory shock with the characteristics of a secondary systemic capillary leak syndrome. The role of endothelial lesions may be discussed.
Surgery of metastatic adrenocortical carcinoma may be complicated by severe hemodynamic complications, even in the absence of hormonal secretion.
肾上腺皮质癌是一种罕见的肾上腺恶性肿瘤，可能会出现延迟转移。对于无分泌功能的肿瘤或转移瘤，诊断可能会延迟，即便如此，手术治疗也可能会很复杂。
一名55岁男性因近期肝脏活检显示为不明类型的肝内巨大肿块而接受择期手术。他曾有过一次无分泌功能的肾上腺肿瘤病史，该肿瘤于十年前接受过手术。术前，他症状轻微，动脉血压正常。麻醉诱导过程顺利，但在肿瘤切除和取出时，他出现了严重的血管麻痹和休克，并伴有无尿性肾衰竭、乳酸酸中毒、四肢及腹腔间隔室综合征。患者于第9天死于延迟性感染并发症。根据病理检查结果，该肿瘤为无分泌功能的肾上腺皮质癌。
肾上腺皮质癌（ACC）较为罕见，当肿瘤分泌激素并类似嗜铬细胞瘤时，会因激素过度分泌而有多种临床表现。我们的患者在初次发病十多年后接受了肝内巨大无分泌功能转移瘤的切除术。围手术期和术后管理因难治性休克而变得复杂，其特征为继发性系统性毛细血管渗漏综合征。内皮损伤的作用值得探讨。
转移性肾上腺皮质癌的手术可能会因严重的血流动力学并发症而变得复杂，即使不存在激素分泌情况。
