ANNALS OF CLINICAL ONCOLOGY | ISSN 2674-3248 Available online at www.sciencerepository.org Science Repository * Correspondence to: Mohamed Ali Chaouch, Charles Nicolle Hospital, Department B of Surgery, Tunis, Tunisia; Tel: +21626205105; E-mail: Docmedalichaouch@gmail.com © 2019 Mohamed Ali Chaouch. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository. All rights reserved. http://dx.doi.org/10.31487/j.ACO.2019.01.02 Research Article Giant adrenocortical carcinoma simulating a liver tumor Mohamed Ali Chaouch 1* , Hichem Jerraya 1 , Wejih Dougaz 1 , Ibtissem Bouasker 1 , Aïcha Ben Miled 2 , Ramzi Nouira 1 and Chadli Dziri 1 1 Charles Nicolle Hospital, Department B of Surgery, Tunis, Tunisia 2 Charles Nicolle Hospital, Department Radiology, Tunis, Tunisia A R T I C L E I N F O Article history: Received: 16 January, 2019 Accepted: 11 March, 2019 Published: 28 June, 2019 Keywords: Adrenocortical carcinoma adrenal cancer prognosis mitotane A B S T R A C T Adrenocortical carcinoma is a rare malignant tumor which can reach large sizes if it is nonfunctioning. In that situation, it can pose diagnosis dilemmas regarding the origin and the nature of the tumor. We reported a case of non-secreting and large right Adrenocortical carcinoma which arose in the posterior costophrenic angle mimicking a liver tumor. A 45-year-old man presented with a voluminous abdominal mass in the right upper quadrant. The different imaging modalities including ultrasound computed tomography and magnetic resonance imaging were discordant as regards the hepatic or the adrenal origin of the tumor. Percutaneous biopsy allowed to determine the diagnosis of the cortico-adrenal tumor. The patient underwent laparotomy. The tumor which arose from the right adrenal gland was resected. Pathology confirmed the diagnosis of adrenocortical carcinoma with histological factors of poor prognosis. The patient was given Mitotane as adjuvant therapy. After six years of follow-up, a tumor recurrence has been diagnosed. © 2019 Mohamed Ali Chaouch. Hosting by Science Repository. All rights reserved. Introduction Adrenocortical carcinoma (ACC) is a rare but aggressive tumor [1]. Its diagnosis relies in most of the cases on hormonal workup and imaging [1]. However, in the case of a nonfunctioning and large tumor, the diagnosis of ACC may be difficult and other non-adrenal pathologic conditions may be discussed [2]. We reported a case of non-secreting and large right ACC which arose in the posterior costophrenic angle mimicking a liver tumor. Case report A 45-year-old man, with no previous medical history, complained of pain in the upper right quadrant for 3 months without fever or jaundice. The physical exam found a large poorly limited abdominal mass in the right upper quadrant. The rest of the physical exam was unremarkable. Abdominal ultrasound showed a large mass in the right upper quadrant of 17 cm which appeared heterogeneous, hyperechogenic and well circumscribed. The origin of this tumor was difficult to assess. Abdominal computed tomography (CT) showed the large mass which was well limited with peripheral contrast enhancement and a central necrotic area which contained some calcifications (Figure 1). This mass extended from the hepatic dome to the upper pole of the right kidney, which was pushed downwards. The right adrenal gland was not seen making the diagnosis of the hepatic or adrenal origin of the mass also difficult to determine. Elsewhere, there was no lymphadenopathy or metastasis. Magnetic resonance imaging (MRI) showed that this mass arose from segments 5, 6 and 7 of the liver. The tumor was heterogeneous, measuring 20 x 17 x 13 cm with hyposignal on T1- weighted images, hypersignal on T2-weighted images and early enhancement during the arterial phase then it became homogeneous in portal phase with persistence of a central area of necrosis (Figure 2.A). The mass was well circumscribed by a capsule which was hypointense on T1 and T2-weighted images. It came into contact with the right portal branch and the inferior vena cava which were repulsed to the left but remained permeable (Figure 2.B). Liver function tests were normal and both alpha-fetoprotein and CA19-9 levels were normal (4.2 ng/ml and 8.6 IU/l respectively). Given that the nature of the tumor remained indeterminate, a percutaneous CT-guided biopsy was performed, and it