Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India

For 18 months, a 3-year-old kid demonstrated iso-sexual precocious puberty. Left suprarenal mass was seen on radiological scans, and testosterone and dehydroepiandrosterone-sulfate levels were significantly elevated. The youngster underwent open adrenalectomy, and adrenocortical cancer was found by histology. The youngster is doing well during the three-month follow-up.

Keywords: virilization, adrenalectomy, and adrenal carcinoma

The age distribution of adrenocortical neoplasia is bimodal, peaking in the first and fifth decades. Children's adrenocortical neoplasms are rare, making up 0.3% of all paediatric neoplasms and 6% of all adrenal neoplasms. [1] The estimated incidence of virilizing adrenal carcinoma is 1 case/1.7 million people, making it a relatively uncommon condition. [2] Girls are more likely than boys to have it. In this case study, a 3-year-old kid with virilizing adrenal cancer presented with iso-sexual precocious puberty.

A 3-year-old kid gave growth of the penis and pubic hair for quite some time and developing of voice and axillary hair for quite a long time. On assessment, the kid was generally sound and normotensive Pubic hairs, axillary hairs and hairs in the facial hair region and upper lip were available. Extended penile length was 9.8 cm. Respective testicles were typically plummeted and ordinary in size. There were no skin spots and no proof of elements of Cushing disorder. No bump was obvious on stomach assessment. Spine and advanced rectal assessments were mediocre.

His hemoglobin was 14.0 g% and blood natural chemistry reports were ordinary, aside from serum soluble phosphatase which was 939 U/l. Serum electrolytes were Na: 137 meq/l and K: 4.2 meq/l. Chest X-beam was typical.An abdominal ultrasound indicated a left adrenal solid mass with a few possible calcifications. A massive 6847 mm soft tissue density mass with uniform contrast enhancement was visible on contrast-enhanced computed tomography (CT) of the whole abdomen, pushing the left kidney lower and surrounded by a thin enhancing capsule that resembled a rim.The child underwent a subcostal transperitoneal technique for a left open adrenalectomy. The postoperative phase went off without a hitch.A well-defined, encapsulated nodular tumour measuring 6.7 cm in greatest axis and weighing 125g was discovered during histopathology.

The cut-section displayed a variegated pattern with areas of bleeding and necrosis as well as soft and friable intratumoral nodules. Microscopically, it was composed of tumour gigantic cells with peculiar hyperchromatic nuclei and rich eosinophilic cytoplasm, as well as big polygonal cells with vesicular nuclei and conspicuous nucleoli, strong nuclear pleomorphism, and mitotic figures that were >20/50 hpf. The serum levels of DHEA-S and testosterone recovered to normal two weeks after surgery. The child is doing well at the three-month checkup, and the chest X-ray and entire abdominal ultrasonography are both normal.

Adrenocortical carcinomas with blended virilizing and Cushing's disorder are commonplace, yet unadulterated virilizing adrenocortical carcinomas are exceptional, containing 5-10% of the cases in most enormous series.[3] Virilizing adrenocortical carcinoma causes iso-sexual gifted adolescence in young men and virilization in young ladies. The hormonal profile is evaluated by assessing the serum levels of testosterone, DHEA-S, β-HCG, FSH and cortisol and urinary 17-ketosteroid and 17-hydroxycorticosteroid. Most cases with virilization have raised degrees of dehydroepiandrosterone. Raised testosterone levels are generally credited to fringe change of adrenal androgens.

Our patient had especially expanded serum testosterone and serum DHEA-S. High groupings of adrenal androgens, particularly DHEA-S, are profoundly reminiscent of a virilizing cancer and differentiation upgraded CT-midsection restricts the adrenal mass.

Visualization for harmless adrenal growths is superb. Then again, normal visualization for adrenocortical carcinoma is for the most part poor, with a general 5-year endurance of 20-25%. Factors related with unfortunate anticipation, explicitly for virilizing cancers, incorporate fragmented resection, weight >80 g, volume >200 ccm, age >3.5 years at finding, preoperative side effect length >6 months and stamped expansion in urinary 17-ketosteroid and 17-hydroxysteroids. Unadulterated virilizing carcinomas overall seem to have a preferable forecast over other adrenal carcinomas.[4] For our situation, unfortunate prognostic variables were cancer weight 125 g and preoperative side effect span year and a half.

Bugg et al. used the changed models of Weiss to investigate pediatric adrenocortical tumors.[4] This arrangement depended on mitotic record, blended rot, abnormal mitosis and atomic grade. As per this characterization, our patient had high-grade adrenocortical carcinoma.

As to, for our situation, the cancer was totally resected with a negative edge, weighed 125 g and there was no proof of metastasis. The unusual chemical levels got back to business as usual after medical procedure and accordingly our case was marked as stage 1, high-grade adrenocortical carcinoma.

Thus, it is presumed that a kid with virilizing side effects ought to be quickly researched for biochemical profile and radiological imaging. Careful resection is the treatment of decision. Medical procedure is the main conclusive helpful methodology in kids, which can be corrective provided that adrenocortical carcinoma is analyzed early and treated speedily.

Adjuvant chemotherapy is utilized for metastatic or intermittent infection, yet lack of cases makes its assessment difficult.[5] The job of radiotherapy is questionable.

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Punit Tiwari . A rare case of virilizing adrenal cancer in a 3-year-old kid. World Journal Of Hematology And Oncology 2022.