# Massive non-functioning Adrenocortical carcinoma presenting as acute abdomen without rupture: A case report

## TL;DR

A rare case of large adrenal cancer presented as sudden abdominal pain and was successfully treated with surgery.

## Contribution

Demonstrates acute abdomen as a rare ACC presentation without rupture and successful surgical management.

## Key findings

- A 39-year-old male had a massive adrenal tumor causing acute abdomen successfully removed without rupture.
- The patient remains disease-free for 36 months without adjuvant therapy.
- Acute abdomen can be an ACC symptom even without tumor rupture, allowing timely resection.

## Abstract

Adrenocortical carcinoma (ACC) is a rare, aggressive malignancy with diverse clinical presentations. Acute abdomen is an exceptionally uncommon manifestation, typically reflecting tumor rupture. We report a 39-year-old male presenting with acute abdominal pain and a palpable left upper-quadrant mass. Imaging demonstrated a massive adrenal tumor (17.8 × 15.1 × 20.2cm). En-bloc resection with negative margins was achieved without rupture while preserving adjacent organs. Histopathology confirmed ACC. The patient remains disease-free 36 months postoperatively without adjuvant therapy. Acute abdomen can be the presenting symptom of ACC even without tumor rupture. Timely intervention can prevent possible impending rupture, enabling complete resection and favorable oncological outcomes.