Adrenocortical Carcinoma in a Young Adult Male with Chronic Urticaria: A Case Report and Literature Review - Beyond the Abstract

Adrenocortical carcinoma (ACC) is a rare malignancy with an incidence of 0.7–2.0 cases/million habitants/year. The diagnosis of malignancy relies on careful investigations of clinical, biological, and imaging features before surgery and pathological examination after tumor removal.1 We reported a case of a 23-year-old male patient who presented with persistent left flank pain and urticaria for 3 months. Imaging studies confirmed the presence of a large left adrenal mass with malignant features. The biochemical workup was unremarkable. Open left radical adrenalectomy was performed, the final pathologic examination showed ACC with negative surgical margins. The patient remained disease-free for eighteen months period of follow-up after surgery.2

The patient’s urticaria may be related to the decreased serum concentration of Dehydroepiandrosterone and its sulfate derivative (DHEA-S) level. The current knowledge prevents answering whether lower circulating DHEA-S concentration is a primary phenomenon or just an accompanying one which appears as a response of different systems to the course of the illness and may not be of any importance for the pathogenesis of urticaria whatsoever.3

We proved that that complete surgical resection (R0 excision) offers the best chance for long-term survival in patients with stage II ACC. We also demonstrated the possible association of the malignant disease with chronic urticarial.2

Written by: Mohamad Moussa,1 Mohamad Abou Chakra,2 Yasmin Moussa3

  1. Chairman of Urology Department, Faculty of Medicine, Lebanese University, Al Zahraa Hospital, Beirut, Lebanon.
  2. Department of Urology, Faculty of Medicine,  Lebanese University, Beirut, Lebanon.
  3. Clinic of Dermatology, Dr. Brinkmann, Schult & Samimi-Fard, Barbarastraße, Gladbeck, Germany

  1. Libé R. Adrenocortical carcinoma (ACC): diagnosis, prognosis, and treatment. Front Cell Dev Biol. 2015;3:45.
  2. Moussa Y, Moussa M, Abou Chakra M. Adrenocortical carcinoma in a young adult male with chronic urticaria: A case report and literature review. Int J Surg Case Rep. 2020;66:330-333.
  3. Kasperska-Zajac A. Does dehydroepiandrosterone influence the expression of urticaria?-a mini review. Inflammation. 2011;34(5):362-6.
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