TY - JOUR
AR - SCR-2021-7-103
TI - Preoperative Transcatheter Arterial Embolization and En-Bloc Resection for Giant Non-Functioning Left Adrenocortical Carcinoma: A Case Report
AU - Giorgio , Lucandri
AU - Giuseppe, Mezzetti
AU - Marco, Maria Lirici
AU - Alessia, Fassari
AU - Vito, Pende
AU - Simone, Vagnarelli
AU - Daniela, Bosco
AU - Antonio, Spada
AU - Assunta, Santonati
AU - Domenico, Campagna
AU - Massimo, Farina
JO - Surgical Case Reports
PY - 2021
DA - Thu 08, Jul 2021
SN - 2613-5965
DO - http://dx.doi.org/10.31487/j.SCR.2021.07.03
UR - https://www.sciencerepository.org/preoperative-transcatheter-arterial-embolization-and-en-bloc-resection_SCR-2021-7-103 
KW - Adrenocortical carcinoma, mitotane, multi-visceral resection, non-secretory tumor, retroperitoneal tumor, transcatheter arterial embolization
AB - Objective: To demonstrate efficacy and relative safety of compartment surgery in a case of large sized adrenocortical carcinoma (ACC), whenever associated with preoperative transcatheter arterial embolization (TAE) and adjuvant treatment with mitotane.
Introduction: ACC is a rare illness; non-functioning lesions account for 40-55% of patients, may reach a large size, and show a clear attitude to infiltrate neighbouring organs.
Case Report: Middle aged male visited for a huge left abdominal mass; contrast CT scan showed origin from the left adrenal lodge and possible extension of the tumor to surrounding structures. Preoperative adrenal work-up confirmed non-functioning nature of the adrenal mass. In order to allow a safe compartment excision and to decrease blood loss, preoperative angiography and TAE was performed. Patient underwent en-bloc resection of the mass, together with nephrectomy and distal splenopancreasectomy. No postoperative transfusions were required. Patient received adjuvant therapy with mitotane for 36 months since surgery, without any sign of tumor recurrence.
Conclusion: An aggressive surgical approach seems justified also in locally advanced and infiltrating ACC; compartment resection is mandatory in order to obtain adequate resection margins. Preoperative TAE decreases intraoperative blood loss and need for transfusions. Adjuvant treatment with mitotane may contribute to reach remarkable disease-free survival.