A retrospective analysis of patients with adrenocortical carcinoma

We present a series of nine patients with adrenocortical carcinoma (ACC) treated at our institution from 1981 to 2005. All patients presented with hormonal excess, including three with primary hyperaldosteronism, two with virilization, and four with Cushing's syndrome. ACC was suspected preoperatively in all of the patients because CT and/or MRI showed irregular shaped masses that were enhanced heterogeneously. Preoperative stages were as follows; Stage I in two patients, II in three, III in two, and IV in two. Operation was performed for Stage I to III patients (n=7). O,p'-DDD (Mitotane) was used for two patients in Stage IV and one patient who had recurrence after the operation. The median survival was 39 months of these seven patients operated on, two patients in Stage I and II are currently disease free, three experienced recurrence, and the remaining two died. Other two patients who were not operated on died. Repeated resections of distant metastases in one of the Stage II patients led to a long-term survival for 87 months after the first operation. All Stage III patients died shortly after the recurrence. O,p'-DDD was not effective. Stage I and II patients had better prognosis than Stage III and IV patients. When the locally controlled early stage patient developed distant metastasis, repeated resections of these lesions provided a long-term survival. (author)