Adrenocortical carcinoma and sudden death

Area of Science:

• Oncology
• Pathology
• Cardiovascular Medicine

Background:

• Adrenocortical carcinoma is a rare malignancy with a poor prognosis.
• Vascular invasion is a common feature of adrenocortical carcinoma.
• Sudden death due to pulmonary thromboembolism is an uncommon presentation of adrenocortical carcinoma.

Purpose of the Study:

• To report a rare case of sudden death caused by pulmonary thromboembolism secondary to adrenocortical carcinoma.
• To discuss the potential mechanisms and clinical implications of this phenomenon.

Main Methods:

• Case report of a 26-year-old male with adrenocortical carcinoma.
• Clinical presentation, imaging, autopsy findings, and histopathological examination were reviewed.
• Literature review on adrenocortical carcinoma with vascular invasion and thromboembolism.

Main Results:

• The patient presented with gynecomastia, fever, night sweats, and abdominal distension, indicative of advanced adrenocortical carcinoma with liver and spine metastases.
• Autopsy revealed a saddle pulmonary thromboembolus originating from a tumor extension into the inferior vena cava via the left adrenal vein.
• No tumor cells were identified within the thromboemboli, suggesting a non-thrombotic mechanism or rapid tumor embolization.

Conclusions:

• Adrenocortical carcinoma can lead to sudden death through pulmonary thromboembolism, even without tumor cells in the emboli.
• Vascular invasion and tumor extension into the inferior vena cava are critical risk factors for this fatal complication.
• Increased awareness and vigilance for thromboembolic events are warranted in patients with adrenocortical carcinoma, particularly those with known vascular invasion.