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Rare disease
Giant adrenal pseudocyst harbouring adrenocortical cancer
  1. Michael Wilkinson,
  2. Deirdre Mary Fanning,
  3. James Moloney,
  4. Hugh Flood
  1. Urology Department, Midwestern Regional Hospital, Limerick, Ireland
  1. Correspondence to Miss Deirdre Mary Fanning, fanningdee{at}


The authors report a very rare case of adreno-cortical carcinoma arising in a giant adrenal pseudocyst. A 64-year-old woman presented to the emergency department with a 6 week history of progressively worsening severe left abdominal pain, anorexia, anergia and constipation. On examination, she was cachectic with tenderness over the left abdomen and flank. Medical history was significant for gastritis and anaemia. During her investigation, a well-defined para-renal 12×6 centimetre multi-loculated cyst, of uncertain origin was identified on CT. Ultrasound-guided biopsy was not diagnostic. MRI showed the cyst to be likely adrenal in origin. Serum and urinary catecholamines were unremarkable. At laparotomy an unresectable large, tense, fixed, cystic mass was seen to occupy the left side of the abdomen. The cyst was de-roofed. Pathology showed a high-grade poorly differentiated adreno-cortical carcinoma with a pseudo-capsule. She died 2 months postoperatively.

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  • Competing interests None.

  • Patient consent Obtained.

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