A case report of cytoreductive surgery of metastatic adrenal cancer in a patient with tumor progression.

Background: Adrenocortical cancer is a rare malignancy with high risk of relapse and disease progression. The approaches to the treatment of relapse cases are not sufficiently clearly defined by current clinical guidelines.

Case description: Male patient O., born in 1967, has been suffering from the cancer of right adrenal gland since 2020. The patient underwent right-sided epinephrectomy in April 2020. Later he got several courses of chemotherapy with the mixed results. Then he underwent laparoscopic cytoreductive assisted excision of the recurrent neoplasm of the right adrenal gland on 04 April 2024, and received everolimus 10 mg per day postoperatively. There was evidence of recurrence of adrenocortical cancer of the adrenal gland with invasion of the fibrous capsule without signs of tumor growth at the edges of the resection. According to immunohistochemistry data, there was a decrease in phosphatase and tensin homolog deleted on chromosome 10 (PTEN) expression, an increase in Ki-67 expression, and a lack of programmed death-ligand 1 (PD-L1) expression. According to multispiral computed tomography data from May 2024 they found an increase in cells in the lungs by 2 mm, an increase in cells in the liver by 18 and 6 mm, an increase in paracaval lymph nodes by 12 mm. The given case of relapse and progression of the disease is of interest, because the removal of part of the liver during cytoreductive surgery and preservation of the kidney improve the quality of life. Due to limited resources hyperthermic intraperitoneal chemotherapy (HIPEC) and other methods of intraoperative chemotherapy were not applied.

Conclusions: Cytoreductive surgery is an important option for complex treatment in the advanced stages of adrenocortical cancer.