Locally advanced adrenal tumor invading the stomach revealed by upper gastrointestinal hemorrhage: a case report

Introduction and importance: Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy, often diagnosed at an advanced stage. Direct invasion into adjacent organs is possible, but gastric involvement is exceedingly uncommon. We report a rare case of a locally advanced adrenal tumor invading the stomach and presenting with upper gastrointestinal bleeding. Case presentation: A 42-year-old man presented with hematemesis and melena evolving over 24 h. Physical examination revealed pallor, hypotension, and a palpable left upper quadrant mass. CT imaging showed a large left adrenal mass (15 × 14 × 10 cm) invading the posterior gastric wall and compressing adjacent structures, with thrombi in the inferior vena cava and portal vein. Hormonal studies excluded a functional tumor. Percutaneous biopsy confirmed ACC. The patient underwent en bloc resection including total gastrectomy, left nephrectomy, and partial vena cava resection with reconstruction. Histopathology confirmed high-grade ACC with negative margins. Clinical discussion: ACC rarely presents with gastrointestinal bleeding. Gastric invasion is exceptional and poses diagnostic and therapeutic challenges. Complete surgical excision remains the cornerstone of treatment and offers the best chance for prolonged survival. Conclusion: This case highlights an unusual presentation of ACC revealed by upper gastrointestinal hemorrhage, emphasizing the importance of early recognition and multidisciplinary management.