Solitary Progression to Bone: A Rare Manifestation of Adrenocortical Carcinoma
https://doi.org/10.15605/jafes.041.S1
- Author:
Mohd Fyzal Bahrudin
1
;
Jia Miao Tan
1
;
Chin Voon Tong
1
Author Information
1. Endocrine Unit, Department of Medicine, Hospital Putrajaya
- Publication Type:Journal Article
- MeSH:
Adrenocortical Carcinoma
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):31-32
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Adrenocortical carcinoma (ACC) is a rare and aggressive
malignancy with a predilection for metastasis to the liver,
lungs, and lymph nodes. Bone involvement is less common
and typically occurs alongside widespread disease.
Isolated skeletal progression without visceral involvement
is unusual and not well characterized.
Case:A 60-year-old female underwent left adrenalectomy in
2019 for an incidentally detected adrenal mass, which
was reported as a benign adrenal cortical adenoma (Ki67 <3%). In 2022, she presented with persistent low
back pain. Imaging demonstrated fluorodeoxyglucoseavid lesions involving the T12 vertebra and right
ilium, without evidence of local recurrence or visceral
metastases. Histopathological evaluation of a bone biopsy
initially suggested a neuroendocrine neoplasm based
on synaptophysin positivity. Following multiple expert
reviews and integration of clinical, radiological, and
immunohistochemical findings, a consensus diagnosis of
metastatic ACC was established.
She received palliative radiotherapy to symptomatic
skeletal sites and subsequently completed six cycles of
etoposide, doxorubicin, and cisplatin chemotherapy in
2023, achieving disease stabilization. Surveillance imaging
in May 2025 demonstrated progression confined to the
axial and appendicular skeleton, with no involvement of
the adrenal bed or visceral organs. Mitotane therapy was
initiated in December 2025. Ongoing management focuses
on systemic disease control, symptom palliation, and
multidisciplinary supportive care.
Conclusion:This case illustrates an uncommon pattern of ACC
progression characterized by bone-dominant metastases
in the absence of visceral disease. It also highlights the
importance of reconsidering the initial histopathological
diagnosis when clinical behavior is discordant. Vigilance
for atypical metastatic patterns is warranted, even years
after resection of an adrenal lesion initially classified as
benign.
- Full text:2026072815182914060EP_A024.pdf
