In May 1997, a 29-year-old woman underwent surgery in another center for a carcinoma of the left adrenal gland clinically non-functioning, which clinically manifested as discomfort in the left adrenal mass intra-abdominal computed tomography scan left gamma cm.
In the analyses, there was a slight increase in cortisoluria (284.5 mcgr.h.) and 17-OH-steroids (12.7 mcg./24h) without symptoms of systemic hyperalgesia.
Complete resection of the tumor was performed, with the histological diagnosis of adrenal carcinoma 10 x 7 x 5 cmts.
(215 grs.) well encapsulated, although with vascular invasion, large areas of necrosis and a mitotic index of 5.8/50; the histochemical study was (+) for Vimentin and (-) for Cytokeratin
It was labelled as Stage II and Grade II.
Thirty months later, the patient developed a mass in the previous resection bed of 7 cm, in contact with the left renal hilium and was technically resectable. A distal panphrenic resection was performed and a distal pancreat
Subsequently, she received adjuvant systemic chemotherapy with 6 complete cycles of cisplatin (CDDP) and cisplatin-toposide (VP-16) in adjuvant regimen.
Four years and eleven months after initial treatment, radiological follow-up detected the presence of several hepatic nodules suggestive of metastasis.
After control with intraoperative hepatic ultrasound, a bisegmentectomy IV-B and V and limited resection of segment VIII were performed. Pathological anatomy analysis revealed a variable size of 1.5 cm adrenal carcinoma.
Ten months later, a new tumor recurrence was detected at the upper subdiaphragm level and the left coronary artery (from 6 x 4 cm. according to the TAC) and at the root of the mesentery, the latter was located 4 x 3 cm.
Given the difficult resectability of the new recurrence, chemotherapy with neoadjuvant intent was decided (five complete cycles of PDPV and PV-16), a new partial regression of the lesions was achieved through surgical exploration.
The resection of the two tumor masses was performed, the first including the left pillar of the diaphragm and a 5 cmt sheath of the muscle, and the second dissecting the entire tumor vessel between the celiac trunk and the entire tumor.
Pathology confirmed the recurrence, and the resection margins were unaffected.
The postoperative course was satisfactory.
The patient is, 7 years and 3 months after the diagnosis of the primary tumor, free of disease and with an acceptable quality of life, minimally limited by diarrheal stools secondary to sympathetic denervation celiac disease.
