By Kratiz 
HEY!!!
I’m narrating a story of a patient who was admitted in our unit of surgery department in my college. and what It was a rare case which we were seen and treated and discharged happily, and now she is living her life happily.
A 33 yrs old lady resident of UP came to our OPD on the very first day of 2026 i.e. 1st jan of 2026. with complaints of pain in abdomen in right lumbar region since 15 days with lump in abdomen since 15 days.
yes it is ….
it was a new case to us to study about .. we examined and investigated her as a case of lump in abdomen.
so let’s learn then…
patient was apparently alright 15 days back when she started having pain in abdomen in lumbar region which was sudden in onset , dull aching in nature , aggravated on straining. patient noticed a swelling in right lumbar region after the pain started. and the lump initially of size like a lemon then progressed to current size of a ball.
there were no h/o fever/ trauma to that area/ vomiting/ constipation/ urinary complaints/ loose stools.
she had past history of 2 vaginal deliveries and no other h/o hospitalizations. taking normal mixed diet , having no h/o bowel and bladder complaints. and no h/o any addictions. and no significant family history.
on Examination she was vitally stable , mobile , having normal systemic examination, on per abdomen – soft , non tender , no guarding and rigidity, a single lump of size 3×3 was palpable in right lumbar region , non mobile.
we admitted her and then basic routine investigations were done…
she had normal CBC’s , LFT, KFT values..
Xrays were within normal range..
USG A+P s/o well defined heterogenously hyperechoic mass lesion measuring 5.4×8.0 cm likely arising from right adrenal gland f/s/o adrenal myelolipoma / chronic adrenal hematoma. again senior USG s/o neoplastic etiology , possibility of adrenal angiomyolipoma.
CECT A+P s/o neoplastic etiology likely adreno-cortical carcinoma arising from right adrenal gland.
HRCT thorax s/o no significant abnormality of lung parenchyma.
after this we did adrenal gland investigations and sent patient to consult and endocrinologist…
who were investigated her and ofcourse it was a new rare case to them also..
some says it is a case in millions..
so we treated her like that only..
her blood investigations are like…
lipid profile : CHO– 96 mg/dl, TG– 68 mg/dl, HDL– 28 mg/dl
HBA1C– 4.9%
SR. CORTISOL ( MORNING)– 1.10 ug/dl
ACTH – 1.86 pg/ml, Sr. CORTISOL(8AM) – 10.63 ug/dl
PLASMA- FREE METANEPHRINES– <2.91 ng/L, free NORMETANEPHRINES– 93.07 ng/L, 3- methoxy tyramine- 7.43 ng/L
STEROID PANEL- ALDOSTERONE- 139ng/L, ANDROSTENEDIONE- 10900 NG/L , CORTISOL– 82.30 ug/L, CORTISONE – 17 ug/L, CORTICOSTERONE– 2.58 ug/L, 11-DEOXYCORTISOL – 0.09 ug/L, 21-DEOXYCORTISOL- 0.41 ug/L, DHEA– 67.90 ug/L, DHEAS – 8910 ug/L, 11-DEOXYXORTICOSTERONE- 0.06 ug/L, 17-a-hydroxyprogesterone – 0.28 ug/L, PROGESTERONE – 0.17 ug/L, TESTOSERONE – 1.74 ug/L
URINE METANEPHRINES– 55.4 ug/L
2DECHO s/o normal colour doppler study.
diagnosis was made as RIGHT ADRENOCORTICAL CARCINOMA WITH NO METASTASIS.
and then she was planned for operation with procedure called RIGHT OPEN ADRENALECTOMY.
she was operated and with uneventful procedure patient was shifted to SICU for observation and monitoring for 24 hrs…
excised adrenal gland sent for histopathology.
then around 3am next day patient had tense abdomen , USG efast s/o collection in abdomen. then again we suspected leakage from suture site…
patient’s vitals were deteriorated we thought for a moment that patient will not survive but as a surgeon we decided to re-exploration or re-open the patient .
then at the odd hours our AP came to operate and re-open the patient and it was like .. thank god we re open the patient and do the surgery for her complications.
then again patient shifted to SICU for observations
meanwhile her Hb was dropping then multiple transfusion given …
and patient in the SICU recovered within 2-3 days and shifted to ward …
It was a long duration with patient ….. almost a month happened and she was with us..
we were happy to see her recovery..
and then the comes – we discharged the patient with normal basic antibiotics and we kept her in follow up.
HER HPE report says LOW GRADE ADRENOCORTICAL CARCINOMA ( right adrenal gland)
so this is the story of a patient which was treated by us .. and we were happy to see her recovered and living happily with her family.
every patient teaches you a new thing…
happy learning…
#surgeryresidency