Chaika Oleksander, Maksimovskyi Viacheslav, Smolyk Denys, Ochigava Daviti
Surgery Department, Odesa National Medical University, University Clinic, Odesa, Ukraine.
AME Case Rep. 2025 Jul 15;9:90. doi: 10.21037/acr-24-198. eCollection 2025.
Adrenocortical cancer is a rare malignancy with high risk of relapse and disease progression. The approaches to the treatment of relapse cases are not sufficiently clearly defined by current clinical guidelines.
Male patient O., born in 1967, has been suffering from the cancer of right adrenal gland since 2020. The patient underwent right-sided epinephrectomy in April 2020. Later he got several courses of chemotherapy with the mixed results. Then he underwent laparoscopic cytoreductive assisted excision of the recurrent neoplasm of the right adrenal gland on 04 April 2024, and received everolimus 10 mg per day postoperatively. There was evidence of recurrence of adrenocortical cancer of the adrenal gland with invasion of the fibrous capsule without signs of tumor growth at the edges of the resection. According to immunohistochemistry data, there was a decrease in phosphatase and tensin homolog deleted on chromosome 10 (PTEN) expression, an increase in Ki-67 expression, and a lack of programmed death-ligand 1 (PD-L1) expression. According to multispiral computed tomography data from May 2024 they found an increase in cells in the lungs by 2 mm, an increase in cells in the liver by 18 and 6 mm, an increase in paracaval lymph nodes by 12 mm. The given case of relapse and progression of the disease is of interest, because the removal of part of the liver during cytoreductive surgery and preservation of the kidney improve the quality of life. Due to limited resources hyperthermic intraperitoneal chemotherapy (HIPEC) and other methods of intraoperative chemotherapy were not applied.
Cytoreductive surgery is an important option for complex treatment in the advanced stages of adrenocortical cancer.
肾上腺皮质癌是一种罕见的恶性肿瘤，复发和疾病进展风险高。目前的临床指南对复发病例的治疗方法定义不够明确。
男性患者O.，出生于1967年，自2020年起患有右肾上腺癌。患者于2020年4月接受了右侧肾上腺切除术。后来他接受了几个疗程的化疗，效果不一。然后他于2024年4月4日接受了腹腔镜减瘤辅助切除右肾上腺复发性肿瘤，并在术后每天服用10毫克依维莫司。有证据表明肾上腺皮质癌复发，侵犯纤维包膜，切除边缘无肿瘤生长迹象。根据免疫组化数据，10号染色体上缺失的磷酸酶和张力蛋白同源物（PTEN）表达降低，Ki-67表达增加，程序性死亡配体1（PD-L1）表达缺失。根据2024年5月的多排螺旋计算机断层扫描数据，他们发现肺部细胞增加2毫米，肝脏细胞增加18毫米和6毫米，腔静脉旁淋巴结增加12毫米。该疾病复发和进展的病例令人关注，因为在减瘤手术中切除部分肝脏并保留肾脏可提高生活质量。由于资源有限，未应用热灌注化疗（HIPEC）和其他术中化疗方法。
减瘤手术是肾上腺皮质癌晚期综合治疗的重要选择。
