Case of an Adrenocortical Carcinoma with Pulmonary Embolism as the Initial Manifestation

Abstract

The annual incidence of a first episode of deep vein thrombosis or pulmonary embolism (PE) in the general population is 120 per 100,000. Cancer is associated with an approximately 4- to 7-fold higher risk of thrombosis. Adrenocortical carcinoma (ACC) is a rare type of malignancy, accounting for 0.02% of all cancers reported annually. Approximately 40% of ACCs are nonsecretory. Most patients with nonsecreting tumors have clinical manifestations related to tumor growth (e.g., abdominal or flank pain). Often the adrenal mass is detected by chance via radiographic imaging. As a result, most ACC patients are diagnosed at an advanced stage and have a poor prognosis. Herein, we report a case of a 54-year-old woman who was admitted to our emergency department complaining of dyspnea. She was diagnosed with ACC accompanied by thrombi in the pulmonary artery and inferior vena cava. We performed a left adrenalectomy and administered adjuvant radiotherapy. The patient is currently receiving warfarin and adjuvant mitotane therapy. She was incidentally diagnosed with ACC, with PE as the initial manifestation.

부신피질암종은 매우 드문 암으로 이 중 비기능성 종양은 종양의 성장과 관계된 복부나 옆구리 통증과 같은 임상 증상으로 발견되거나 방사선검사에서 우연히 발견되며 대부분 진행된 병기에서 진단되어 예후가 매우 나쁘다. 국내에서 폐색전증으로 초기 증상으로 나타낸 부신피질암종은 아직 보고된 바가 없다. 따라서 저자들은 호흡곤란을 주소로 내원한 54세 여자 환자에서 폐색전증을 통해 우연히 부신피질암종을 발견하고 근치적 절제 후 방사선 및 mitotane 치료를 시행 받은 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.