Ms. Ngoc had experienced multiple swollen lymph nodes across her body, from her left groin to her neck, for the past two years. In 8/2025, as the lymph nodes progressively enlarged, she sought medical attention at Tam Anh General Hospital TP HCM. An ultrasound revealed a 12x7cm left supraclavicular lymph node. A subsequent CT scan identified numerous clustered lymph nodes along both the abdominal aorta and pelvic arteries, a lesion on the left adrenal gland, and multiple swollen lymph nodes in the left neck and left supraclavicular region.

Immunohistochemistry results from a core needle biopsy of a left neck lymph node confirmed metastatic cancer, likely originating from the adrenal gland. Doctor Kim Thi Be Diep, from the Department of Medical Oncology at the Oncology Center, Tam Anh General Hospital TP HCM, ordered second-step immunohistochemical staining, which confirmed metastatic adrenal cortical carcinoma in the left supraclavicular lymph node.

Doctor Diep examining Ms. Ngoc. *Photo: Tam Anh General Hospital*

According to Doctor Diep, diagnosing Ms. Ngoc's cancer was challenging because the adrenal gland is located deep within the retroperitoneal space, above the kidneys. This position makes it difficult for common imaging methods like ultrasound and CT scans to detect abnormalities. Furthermore, adrenal cortical carcinoma is rare, presenting with vague symptoms that often overlap with other conditions. Ms. Ngoc's tumor was non-functional, meaning it did not secrete hormones, and therefore remained asymptomatic until it grew large and metastasized to the lymph nodes.

Doctor Diep prescribed chemotherapy to control disease progression and inhibit further cancer cell growth. Ms. Ngoc's medication was prepared in a specialized negative pressure room with sterile isolation, reducing the risk of infection. Doctors adhered to standard preparation procedures, ensuring precise and safe drug dosages for Ms. Ngoc. She has currently undergone three cycles of medication, and her health remains stable.

A technician preparing chemotherapy drugs in a negative pressure room with sterile isolation for Ms. Ngoc's treatment. *Photo: Tam Anh General Hospital*

The adrenal glands are triangular-shaped organs located atop each kidney. Each adrenal gland has two parts: the cortex and the medulla. The adrenal cortex functions to balance water and salt levels in the body, maintain normal blood pressure, and control the use of proteins, fats, and carbohydrates.

Adrenal cortical carcinoma is a condition where malignant cells form in the outer layer of the adrenal gland. Doctor Diep cited data from the US and Netherlands, indicating that the incidence of adrenal cortical carcinoma is one to two cases per one million people annually in the general population.

Risk factors for adrenal cortical carcinoma include: genetic conditions such as Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, and Carney syndrome. Some cases of adrenal cortical carcinoma arise from abnormal cell changes during a person's lifetime.

Common symptoms include abdominal pain, an abdominal mass, back pain, and bloating. However, in its early stages, a malignant tumor in the adrenal cortex may not cause symptoms. Symptoms, such as those seen in Ms. Ngoc's case, typically appear only when the malignant cells have metastasized. If unusual swollen lymph nodes persist for one to two weeks, patients should consult an oncology specialist.

Bao Tram

*Patient's name has been changed