{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T23:34:01Z","timestamp":1781566441949,"version":"3.54.5"},"reference-count":11,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,5,31]]},"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:p>A 61-year-old woman who was originally diagnosed with locally advanced adrenocortical carcinoma (ACC) 10 years ago, developed massive haemoptysis while away from the UK. Initial investigations revealed a left upper lobe lesion requiring embolisation. Bronchoscopic evaluation was unsuccessful in identifying an underlying cause, and cytology was suggestive of an inflammatory cause. A rigid bronchoscopy was planned but prior to this the patient coughed up a lump of tissue which was sent for histopathological examination. Morphology and immunohistochemistry were consistent with metastatic ACC. ACC is a rare and aggressive tumour of the adrenal cortex. The histological appearances of ACC are similar to that of a carcinoid tumour, creating diagnostic difficulty given the presumed endobronchial origin of the expectorated material in this case. Accurate clinical information and judicious use of immunohistochemistry were key to making the diagnosis. To the authors knowledge, this is the first described case of expectorated metastatic ACC.<\/jats:p>","DOI":"10.1136\/bcr-2020-234624","type":"journal-article","created":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T02:19:40Z","timestamp":1593483580000},"page":"e234624","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Expectorated metastatic adrenocortical carcinoma: a rare presentation of a rare tumour"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0860-7371","authenticated-orcid":false,"given":"Adam","family":"Douglas","sequence":"first","affiliation":[{"name":"Cellular Pathology, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK"},{"name":"Cellular and Anatomical Pathology, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Attanoos","sequence":"additional","affiliation":[{"name":"Cellular Pathology, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,6,29]]},"reference":[{"key":"2025082702521105000_13.6.e234624.1","doi-asserted-by":"crossref","first-page":"636","DOI":"10.14740\/jocmr3503w","article-title":"The characteristics and trends in adrenocortical carcinoma: a United States population based study","volume":"10","author":"Sharma","year":"2018","journal-title":"J Clin Med Res"},{"key":"2025082702521105000_13.6.e234624.2","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-13-0519"},{"key":"2025082702521105000_13.6.e234624.3","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.01626"},{"key":"2025082702521105000_13.6.e234624.4","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24030"},{"key":"2025082702521105000_13.6.e234624.5","first-page":"62","article-title":"Role of Mitotane in Adrenocortical Carcinoma - Review and State of the art","volume":"14","author":"Paragliola","year":"2018","journal-title":"Eur Endocrinol"},{"key":"2025082702521105000_13.6.e234624.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa063360"},{"key":"2025082702521105000_13.6.e234624.7","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.critrevonc.2014.05.009","article-title":"Adrenocortical carcinoma: the management of metastatic disease","volume":"92","author":"Fay","year":"2014","journal-title":"Crit Rev Oncol Hematol"},{"key":"2025082702521105000_13.6.e234624.8","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e3181cfb506"},{"key":"2025082702521105000_13.6.e234624.9","doi-asserted-by":"publisher","DOI":"10.3816\/CCC.2008.n.037"},{"key":"2025082702521105000_13.6.e234624.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.b5239","article-title":"Histoptysis or oncoptysis: suggested terms for tissue expectoration","volume":"340","author":"Papagiannis","year":"2010","journal-title":"BMJ"},{"key":"2025082702521105000_13.6.e234624.11","first-page":"138","volume-title":"Bronchial carcinoid: a case report","volume":"2","author":"Pathak","year":"2014"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-234624","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:52:19Z","timestamp":1756288339000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-234624"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6]]},"references-count":11,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6,29]]},"published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1136\/bcr-2020-234624"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-234624","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6]]}}}