Adrenocortical carcinoma with sarcomatoid pattern. Importance of differential diagnoses

Abstract Adrenocortical carcinoma is an infrequent neoplastic variant, with variable symptoms and high aggressiveness in women. The case of a 29-year-old woman with oppressive epigastric pain and irradiation in a semi-belt with weight loss is presented. CT scan showed a right adrenal mass measuring 11.4 cm x 5.9 cm. The histological study showed focal areas of epithelium, with dilated ectatic vessels and the presence of spindle cells in a deer antler. Immunohistochemistry revealed positivity for SF-1, p53, and CD34. Two cycles of chemotherapy with doxorubicin and ifosfamide have been given, in addition to the use of mitotane as an adrenolytic. Due to their appearance, they are treated as adrenal carcinomas, thus limiting adequate clinical improvement. According to the literature, it is a carcinoma with an unfavorable prognosis.