Mixed corticomedullary adrenal carcinoma - case report: Comparison in features, treatment and prognosis with the other two reported cases

•Adrenal incidetaloma could be mixed tumor, and should be considered in every case.•Radiological signs play an important rules in differentiate malignant from benign adrenal tumor.•Complete immunohistochemical study is necessary to confirm pheochromocytoma that presents normally in the clinic.•Additional reported cases and clinical trials are needed to put more effective treatment plans for Mixed corticomedullary adrenal carcinoma.

IntroductionAdrenal corticomedullary adenoma was reviewed in many cases in PubMed Library, While the coincidence corticomedullary adrenal carcinoma in the same gland was just described in two cases in the medical literature. Our case is the third to be reported and was treated with surgery and adjuvant chemotherapy and followed for two years.Presentation of caseA 50-year-old man suffered from a mass effect in the left abdominal side. While the laboratory showed a mild elevation in the levels of both serum cortisol and 24 h urine cortisol, radiological images were highly suggested an adrenal malignant tumor without metastasis. At surgery a 22 cm sized mass was completely resected. Immunohistochemical study identified expression of both adrenocortical carcinoma and pheochromocytoma markers.DiscussionCases of coincidence corticomedullary tumor have been published in many reviews, cortical and/or medulllary hypersecretion were not always detected preoperatively by biochemical tests.Mixed corticomedullary carcinoma are exceedingly rare, we came across three reported cases in medical literature, in one case laboratory tests confirmed both cortical and medulla hypersecretion, while the two others detected only cortical hypersecretion. The final diagnosis was always confirmed by immunohistochemical staining.ConclusionIt could be noted that this is the first comparison of presentation, diagnosis, treatments and follow-up of the three cases of Mixed corticomedullary carcinoma. This could contribute to understanding the behavior and management of this rare malignancy and make it more familiar in clinical practice.