A decade of survival in recurrent nonfunctioning oncocytic adrenocortical carcinoma in a young Filipina

Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with high recurrence risk and limited long-term survival, particularly after metastatic spread. Oncocytic ACC is an uncommon variant that may behave more indolently but can still recur. We report a 30-year-old Filipina with a nonfunctioning oncocytic ACC initially treated with laparoscopic adrenalectomy (R1 margin; Ki-67 10%-20%). She developed local recurrence at 2.5 years, underwent open resection (R1; Ki-67 20%) followed by adjuvant tumor-bed radiotherapy and mitotane, which was discontinued because of intolerance and cost. After a lapse in follow-up, she developed a solitary hepatic metastasis resected with negative margins; planned etoposide, doxorubicin, and cisplatin chemotherapy was stopped after 3 cycles because of ototoxicity. Subsequent surveillance identified a paraumbilical nodal/subcutaneous metastasis resected with negative margins. More than 10 years from diagnosis, she remains under active surveillance without radiographic evidence of active disease. This case highlights the potential for prolonged survival in selected patients with recurrent/metastatic ACC through iterative multidisciplinary decision-making, medical management, and repeat metastasectomy when feasible.