DOI: 10.36347/sjmcr.2015.v03i10.022

Pages: 998-1001

Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with an incidence rate of 1 to 2 per million. Clinical symptoms are mainly related to an excess of steroid hormones or tumor bulk. The most common metastatic sites are the liver, lungs, lymph nodes and bone. Surgical resection remains the cornerstone of treatment. The case mentioned here has two rare characteristics. First that spontaneous rupture of ACC is very rare and secondly associated splenic sub capsular hematoma has never been reported. A 63 year old non-hypertensive male presented in the emergency department with the complaints of pain and gradually increasing lump in the left side of abdomen since last 3 months. On initial clinical examination he was diagnosed to have splenomegaly by emergency medical officer. USG showed to have splenomegaly and left suprarenal mass lesion for which he was referred to urology department. CECT of abdomen revealed heterogeneously enhancing left adrenal ruptured mass lesion with involvement of left kidney and large splenic sub capsular hematoma (13.8x3.2x14.8cms). CEMR findings correlated to CECT. Serum cortisol and urinary metanephrines were normal. Patient was planned for surgery and intraoperatively was found to have locally extensive adrenal tumor with large sub capsular splenic hematoma with left kidney involvement. Adrenalectomy, nephrectomy and splenectomy was done with the palliative intent which relieved patient symptomatically. HPE of specimen showed it to be adrenocortical carcinoma. Though spontaneous rupture of pheochromocytoma and cysts is reported in literature, to our knowledge this is the first reported case of spontaneous adrenocortical carcinoma rupture with sub capsular splenic hematoma.