Rapid Malignant Transformation of Adrenal Cortical Adenoma: A Case Report and Review of the Literature

With the development of science and technology, adrenal incidentaloma (AI) is more and more recognized, and adrenal cortical carcinoma (ACC) is an extremely rare and aggressive cancer of the adrenal gland. According to the report, the risk of malignancy was 0.1% in ACC species with benign initial Computed tomography (CT) features. And, in most cases, a transition period of seven to 10 years is required. In 2018, a patient with an AI was admitted to our hospital. The pathological diagnosis of the operative specimen was adrenal cortical adenoma (ACA). Two years after the surgery, the patient was admitted to our hospital again with abdominal pain and neck pain. CT scan revealed a large retroperitoneal mass with intratumor hemorrhage. Subsequent positron emission tomography (PET) revealed multiple metastases to the liver and bone. The pathological diagnosis of liver and retroperitoneal metastatic lesions was an adrenal cortical tumor (ACT). Given the biological behavior and imaging results of the malignant invasion of the patient's tumor, we finally diagnosed ACC. In this case report, we discuss the cause and possibility of the patient's rapid transition from ACA to ACC in less than two years and review the literature.