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Abstract: The patient presented to the hospital with right-sided lumbar pain for 1 month. The nature of the right retroperitoneal occupancy was unknown after CT examination, and was referred to our hospital from a lower level hospital, where an MDT multidisciplinary consultation was performed after hospitalization. No significant tumor recurrence or distant metastasis was found at the time of regular postoperative follow-up.
Basic information】Male, 67 years old
Disease Type】Adrenocortical carcinoma
Hospital】Fujian Medical University Union Hospital
Date of Consultation】June 2022
Treatment plan】Surgical treatment (right retroperitoneal mass puncture biopsy + laparoscopic right adrenal tumor resection)
Treatment period】Inpatient treatment for 14 days, regular outpatient follow-up
Effectiveness of treatment] No significant tumor recurrence or distant metastasis has been found for the time being.
I. Initial consultation
The patient visited a local hospital for 1 month for right-sided lumbar pain. A CT scan revealed a huge right retroperitoneal occupancy (about 10 cm in diameter) with unclear relationship with the right kidney and right adrenal gland, and the mass was considered large and difficult to operate. The patient and his family were informed in the outpatient clinic that the retroperitoneal mass was huge and possibly malignant, and that the nature of the mass was unknown at the moment, so a multidisciplinary consultation was recommended to assist in the diagnosis after hospitalization. If the puncture pathology results suggest malignancy, surgical resection would be the most effective, but the surgical risk is very high, and the family needs to be fully prepared psychologically and financially, and regular postoperative review is needed to prevent recurrence or metastasis.
II. Treatment process
After hospitalization, the patient’s blood routine, liver function, kidney function, coagulation four + D-dimer, male multiple tumor marker measurement, lung CT, whole abdomen MR scan + enhancement and other related examinations were completed. We invited medical oncology, radiotherapy, interventional medicine, hematology, anesthesiology and other related departments to perform MDT multidisciplinary consultation. Considering that the present tumor was large and its nature was unknown, we performed right retroperitoneal mass puncture biopsy to clarify the source. The pathology report of the first puncture could not clarify the pathological type because most of the tissue was liquefied and necrotic. After 1 week of rest, the patient returned to the hospital for another biopsy of the mass, and the postoperative pathology was inclined to adrenocortical carcinoma. Then laparoscopic right adrenal tumor resection was performed, and the operation went smoothly.
III. Treatment effect
The operation went smoothly, the tumor was removed completely without serious complications, and the postoperative recovery was good. After 14 days of hospitalization, the right retroperitoneal drainage tube and urinary catheter were removed, and the patient was discharged from the hospital with good self-consciousness and the indicators were in the symptomatic state when the relevant tests were repeated. The patient and his family expressed their gratitude to the medical staff.
IV. Notes
We are glad that the patient’s body gradually recovered after the targeted treatment. After discharge from the hospital, we remind the patient to recuperate more, avoid strenuous activities, pay attention to incision care, and strengthen nutrition with high-quality protein. Also note that even if the primary tumor has been surgically removed, it is still necessary to closely follow up and review in outpatient clinic to be alert to local recurrence and distant metastasis. If there are uncomfortable symptoms, such as back pain, you should go to the hospital for review immediately to avoid delaying the treatment.
V. Personal insight
Adrenal malignant tumor is insidious in origin, and preoperative systemic examination for distant metastasis is required. At the same time, the patient’s systemic condition should be taken into consideration, and if surgery is not tolerated, symptomatic supportive therapy can be chosen to improve the quality of life of patients with advanced disease. Because of the presence of some conventional liquefied necrotic tissues in the center of larger tumors, the positive rate of puncture biopsy can be improved by taking the tumor internal and peripheral tissues separately.