Adrenal cortical carcinoma: Paediatric aspects – literature review

Introduction
Adrenocortical carcinoma (ACC) is a rare malignancy in children. Because of this, each patient with suspected ACC requires individualised management, which should be determined at a meeting of a team of multidisciplinary experts in the field.

Aim of the study
To summarise data on symptoms, genetic predisposition, and diagnostic procedures for ACC in children.

Material and methods
Papers were searched in the PubMed database to identify published randomised clinical trials, reviews, systematic reviews, meta-analyses, and case reports.

Results
Most cases of ACC in children occur under the age of 5 years. The most common presenting symptom in 60–80% of paediatric patients is rapidly progressive virilisation. Diagnostics are based on laboratory and imaging evaluation. The mainstay of treatment is surgery, with laparotomy being the preferred method of surgery. Diagnosis is based on histological examination of surgically removed tissue. The Wieneke index is most commonly used in paediatric practice. However, some cases are still classified as “indeterminate histology”. Predisposing genetic factors are found in most children with ACC, most commonly a mutation of the TP53 gene.

Conclusions
Patients should be diagnosed in large clinical centres with experience in this field. The treatment strategy should be individualised. Genetic testing for TP53 gene mutations is indicated in patients with ACC.