Andrenocortical carcinomas: Twelve-year prospective experience(294 views) Tauchmanovà L, Colao A, Marzano LA, Sparano L, Camera L, Rossi A, Palmieri G, Marzano E, Salvatore M, Pettinato G, Lombardi G, Rossi R
World J Surg (ISSN: 0364-2313), 2004 Sep; 28(9): 896-903.
Dept. of Molec./Clin. Endocrinol., Federico II University of Naples, Via S. Pansini 5, 80131 Naples, Italy
Dept. of Anat. Pathol. and Cytology, Federico II University of Naples, Via S. Pansini 5, 80131 Naples, Italy
Dept. of Biomorphol. and Funct. Sci., Federico II University of Naples, Via S. Pansini 5, 80131 Naples, Italy
Dept. of Molec. /Clin. Endocrinol., Federico II University of Naples, Via S. Pansini 5, 80131 Naples, Italy
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Thompson, N. W., Cheung, P. S. Y., Diagnosis and treatment of functioning and nonfunctioning adrenocortical neoplasms including incidentalomas (1987) Surg. Clin. North Am., 67, pp. 423-436
S reide, J. A., Brabrand, K., Thoresen, S., Adrenal cortical carcinoma in Norway, 1970-1984 (1992) World J. Surg., 16, pp. 663-668
McFarlane, D. A., Cancer of the adrenal cortex: The natural history, prognosis and treatment in a study of fifty-five cases (1958) Ann. R. Coll. Surg. Engl., 23, p. 155
Luton, J. P., Cerdas, S., Billaud, L., Clinical features of adrenocortical carinoma, prognostic factors, and the effects of mitotane therapy (1990) N. Engl. J. Med., 322, pp. 1195-1201
Henley, D. J., Van Heerden, J. A., Grant, C. S., Adrenal cortical carcinoma: A continuing challenge (1983) Surgery, 94, pp. 926-931
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Wajchenberg, B. L., Albergaria-Pereira, M. A., Adrenocortical carcinoma: Clinical and laboratory observation (2000) Cancer, 88, pp. 711-736
Latronico, A. C., Chrousos, G. P., Extensive personal experience: Adrenocortical tumors (1997) J. Clin. Endocrinol. Metab., 82, pp. 1317-1324
Hutter, A. M., Kayhoe, D. E., Adrenal cortical carcinoma: Clinical features in 138 patients (1966) Am. J. Med., 41, pp. 572-580
Weiss, L. M., Comparative histologic study of 43 metastasizing and non-metastasizing adrenocortical tumors (1984) Am. J. Surg. Pathol., 8, pp. 163-169
Weiss, L. M., Medeiros, L. J., Vickety, A. L., Pathologic features of prognostic significance in adrenocortical carcinoma (1989) Am. J. Surg. Pathol., 13, pp. 202-206
Wooten, M. D., King, D. K., Adrenal cortical carcinoma. Epidemiology and treatment with mitotane and a review of the literature (1993) Cancer, 72, pp. 3145-3155
McKenna, T. J., Miller, R. B., Liddle, G. W., Plasma pregnenolone and 17-OH-pregnenolone in patients with adrenal tumors, ACTH excess or idiopathic hirsutism (1977) J. Clin. Endocrinol. Metab., 44, pp. 231-234
Medonca, B. B., Lucon, A. M., Menezes, C. A., Clinical, hormonal and pathological findings in a comparative study of adrenal cortical neoplasms in childhood and adulthood (1995) J. Urol., 154, pp. 2004-2009
Kaye, T. B., Crapo, L., The Cushing's syndrome: An update on diagnostic tests (1990) Ann. Intern. Med., 112, pp. 434-444
Pommier, R. F., Brennan, M. F., An eleven-year experience with adrenocortical carcinoma (1992) Surgery, 112, pp. 963-970
Haak, H. R., Hermans, J., Van De Velde, C. J., Optimal treatment of adrenocortical carcinoma with mitotane: Results in a consecutive series of 96 patients (1994) Br. J. Cancer, 69, pp. 947-951
Schteingart, D. E., Treating adrenal cancer (1992) Endocrinologist, 2, pp. 149-157
Bates, S. E., Shieh, C. Y., Mickley, L. A., Mitotane enhances cytotoxicity of chemotherapy in cell lines expressing a multidrug resistance gene (mdr-1/p-glycoprotein) which is also expressed by adrenocortical carcinomas (1991) J. Clin. Endocrinol. Metab., 73, pp. 18-29
Hogan, T. F., Gilchrist, K. W., Westring, D. W., A clinical and pathological study of adrenocortical carcinoma: Therapeutic implications (1980) Cancer, 45, pp. 2880-2883
Adrenocortical carcinoma (AC) is a rare tumor with poor prognosis. Twenty-two patients (14 F, 8 M; age 22 to 59 years; median, 43 years) with AC were evaluated prospectively in a single center: tumor stage was I-II in 12 cases and III-IV in 10. The overall survival in our cohort was 41.6 ± 42 months; 16 subjects are still alive. Curative surgery was followed by longer survival than debulking or no surgery (p < 0.0001). The first relapse was highly predictive for further recurrences. Recurrent ACs were progressively more aggressive, and they occurred with variable but ever shorter intervals. At diagnosis, 14 patients (63.5%) presented with features of clear adrenocortical hyperactivity. Despite the absence of clinical signs of hormonal excess, all other patients presented some abnormalities of steroid secretion. The most common clinical findingwas a recent diagnosis of moderate-to-severe hypertension (68%), poorly controlled by pharmacological treatment, often associated with multiple cardiovascular risk factors. High mitotic rate and undifferentiated polymorph cellular pattern were associated with worse prognosis. Response to treatments other than surgery (mitotane chemotherapy) was better in patients treated early after the first surgery. In conclusion, curative surgery was the most effective treatment. Monitoring arterial pressure, endocrine parameters, and metabolic parameters can be helpful for the early detection of AC recurrences.