[Central nervous system metastasis from non-functioning adrenocortical carcinoma: report of a case]

We report a rare case of brain tumor metastasizing from an adrenocortical carcinoma. A 47-year-old man was referred to our department on September 21, 1995, with complaints of episodic loss of consciousness and severe left motor weakness. There was a past history of left adrenalectomy performed in the Department of Surgery of our hospital 9 months before. On admission, computed tomography (CT) and magnetic resonance imaging (MRI) revealed two well circumscribed masses in the right frontal lobe with peritumoral, marked brain edema and metastasis to the lung. The brain tumor was successfully removed via frontal craniotomy 4 days after admission. Histological examination of the tumor specimen revealed metastatic anaplastic cell carcinoma, indicating metastasis from an adrenocortical carcinoma. After chemotherapy with cisplatin, pepleomycin and pirarubicin, he was discharged without neurological deficit. Two months postoperatively, however, the patient received 50 Gy of telecobalt radiation therapy to the whole brain because of recurrence. Three months after-wards, the patient returned complaining of general fatigue. Chest CT scan revealed further enlargement of the lung lesions. Despite repeated chemotherapy, the patient died of lung metastases eight weeks later. Central nervous system metastasis from adrenocortical carcinoma is exceedingly rare. To the best of our knowledge, only 5 cases have been reported. We report here another case of brain metastasis from adrenocortical carcinoma possibly via lung metastasis, and review the pertinent medical literature.