This 31 year old female was originally referred to this hospital one year prior to the final presentation with the complaint of epigastric and right chest discomfort for 3 months. Her menses which were usually irregular had been absent for 5 months. On chest x-ray, the right hemi-diaphragm was considerably elevated apparently due to sub-diaphragmatic causes. In the Outpatient Department it was thought that renal enlargement as well as hepatic enlargement was present on the right. The patient was again referred with increased liver enlargement. She was admitted for further, more intensive investigations including liver biopsy. Mention was made at this stage that the mass was ballottable from the loin. Liver biopsy was productive of tissue that "could represent portion of a neoplasm of endocrine origin, such as adrenal tissue". An aortogram was performed next. This revealed a large vascular tumour presumably of adrenal origin. At operation the specimen demonstrated was removed from the region of the right adrenal gland. Post-operative course was satisfactory.
Specimen is a transected ovoid tumour 22.5 x 12 cms. The tumour is encapsulated and from what can be seen of the external surface it is relatively smooth. Large blood vessels can be seen on the capsular surface, and fibrous adhesions are present. The cut surface shows a lobular pattern of pinkish-grey tissue with areas of hyaline change and haemorrhage, especially centrally. Histological examination showed the tumour to be an adrenal cortical carcinoma.