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Adrenocortical carcinoma, a malignant tumor that occurs in the adrenal cortex, is called adrenocortical carcinoma. Children under 12 years old are relatively more common, and only a few occur in adults.
Figure 1. Adrenocortical Carcinoma.
Adrenocortical carcinoma is characterized by full moon face, rough skin, acne, alopecia and other symptoms. Adrenocortical carcinoma is a malignant tumor, which can show symptoms such as full moon face, buffalo back, rough skin, poor sleep quality, acne alopecia, heart obesity, loss of appetite, female amenorrhea, decreased libido, and male erectile dysfunction.
When the above symptoms occur, it is recommended to go to the hospital for detailed examination. After diagnosis, surgical resection of tumor lesions can be considered, and then chemotherapy drugs can be given to inhibit the proliferation of cancer cells, so as to improve the quality of life and survival time of patients.
Pathological changes: (1) macroscopic view: the tumor volume is generally large, often more than 100g, occasionally more than 1000g, showing invasive growth, unclear boundary, brown yellow or polychromatic section, soft, often bleeding, necrosis and cystic change; (2) Microscopically, the poorly differentiated tumor cells have large heteromorphism, and multinucleated tumor giant cells and mitotic images are often seen; Well differentiated adenoma like tumors are difficult to distinguish from adenomas if they are small and encapsulated. The differences between the two can be referred to the following points: ① cortical cancer is common with extensive bleeding and necrosis, while adenoma rarely has necrosis; ② Destruction of the capsule, invasion of blood vessels and surrounding organizers are generally cancer; ③ More mitotic images, more than 2/10 high power field of vision were malignant, while adenoma mitosis was rare; ④ The cancer has extensive and obvious nuclear atypia, multinucleated tumor giant cells, large nucleolus and intranuclear inclusion bodies; ⑤ The tumor volume and weight have certain reference value. The diameter of adenoma is mostly less than 5cm, and the weight is less than 50g.
Adrenocortical carcinoma is mostly functional, often presenting with feminization, masculinity and adrenal hyperfunction, and prone to local invasion and metastasis. If there is lymphatic and hematogenous dissemination, the average survival time is 2 years. The differentiation between functional and nonfunctional adrenal cortical tumors mainly depends on clinical manifestations, biochemistry and hormone determination.
Adrenal cortical cancer is very harmful. Once the patient delays the disease, the cancer cells are easy to spread and metastasize, which will cause great trouble to the treatment and pose a serious threat to life safety. If the patient has lymph node metastasis and blood vessel metastasis, the survival period of the patient will be greatly shortened. Therefore, for this disease, we should follow the principle of early detection and early treatment. Once we find that our body has abnormal symptoms, we should go to the hospital in time for a comprehensive examination. In the process of treatment, patients should follow the doctor's instructions and take relevant drugs on time and in quantity, so as to reduce their pain as much as possible and prolong the life cycle of patients as much as possible.
Adrenal cortical carcinoma can be diagnosed by clinical manifestations, imaging examination and pathological biopsy.
1. Clinical manifestations. Adrenocortical carcinoma may lead to excessive secretion of glucocorticoids in the fascicular zone of the adrenal gland, which may lead to the symptoms of centripetal obesity such as full moon face, buffalo back (that is, the back fat is very thick), and slender limbs. In addition, the patient's face may have acne, accompanied by feminization and purple lines similar to stretch marks under the skin. However, it should be noted that benign diseases such as Cushing syndrome can also have the above clinical manifestations.
2. Imaging examination. Such as B-ultrasound CT、 MRI, etc., may find a relatively large mass in the adrenal gland. Comparatively speaking, the volume of adrenal cortical carcinoma is relatively large, generally more than 6cm, while adrenal cortical carcinoma below 6cm is relatively rare in clinic.
3. Pathological biopsy. The diagnosis of adrenocortical carcinoma can be preliminarily obtained by imaging examination and the symptoms of the patients. Finally, the doctor will take a piece of pathology through surgery and send it for biopsy, so as to obtain the exact diagnosis.
For adrenocortical carcinoma, it is best to carry out surgical treatment to remove the lesion and the surrounding infected tissues as soon as possible and control the development of the disease. After the operation, we should actively carry out follow-up treatment, such as chemotherapy, radiotherapy, targeted therapy, biomolecular therapy, etc., which is very helpful to accelerate the recovery of the disease. In addition, we should also pay attention to the nursing in life, pay more attention to rest at ordinary times, supplement nutrition in a balanced way, go to the hospital regularly for review, and adjust the treatment plan, so as to get the best treatment effect.
| Treatment | Descriptions |
| Surgical Treatment | Surgical resection of adrenal cortical adenocarcinoma is the first choice for the treatment of adrenal cortical adenocarcinoma, which is suitable for tumors without extensive metastasis. Surgery should completely remove the tumor body, including the removal of surrounding adipose tissue and areas suspected to be invaded by the tumor; The focal recurrent lesions can be resected again; For single or isolated distant metastases, surgery should also be used as far as possible. For stage Ⅰ~Ⅱ and most stage Ⅲ adrenocortical carcinoma patients, radical surgery can be performed. |
| Radiotherapy | Radiotherapy for adrenocortical carcinoma is generally considered to be ineffective, but recent research results show that the sensitivity of adrenocortical carcinoma to radiotherapy is as high as 42%. Postoperative adjuvant radiotherapy (45-55 Gy) for high-risk stage Ⅱ and Ⅲ adrenocortical carcinoma patients can effectively reduce local recurrence. The timing of postoperative adjuvant radiotherapy is within 3 months after operation. For unresectable recurrent adrenocortical carcinoma and metastasis, multi-point radiotherapy for tumor bed and metastasis is feasible. |
| Drug Treatment | Mitoxane is the only adrenal specific drug currently used in the treatment of adrenocortical carcinoma. It is the most commonly used and most effective drug in the treatment of adrenocortical carcinoma. The optimal plasma concentration of mitoxane was 14-20 mg/L. The individual differences of the bioavailability of mitoxane are very large. A few patients can reach the target blood concentration in 4-6 weeks, but most patients need several weeks and months. Cisplatin, etoposide, adriamycin, streptozotocin, vincristine, teniposide and cyclophosphamide have certain curative effects on adrenal cortical carcinoma. |
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