{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:12:09Z","timestamp":1787317929057,"version":"build-2736575974"},"reference-count":10,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T00:00:00Z","timestamp":1775865600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Adrenocortical carcinomas (ACCs) are rare, aggressive tumors often discovered incidentally. These malignancies may present with abnormal hormone secretion or, as in some cases, as non-functioning masses causing discomfort. We present a case of brain metastasis in a patient with a giant ACC. A 50-year-old man presented with headache and dizziness. A computed tomography (CT) scan showed an intracranial lesion within the parenchyma measuring 73*60*46 mm with left internal temporal involvement, abundant vasogenic edema and compressing the lateral left ventricle. Further imaging investigations identified a large necrotic tissue mass measuring 15 cm, located on both sides of the right diaphragmatic dome, in the middle posterior region. Hormonal workup was conducted and excluded a functional adrenal tumor. A CT-guided biopsy was performed, confirming ACC. Despite medical management, the patient\u2019s condition deteriorated rapidly, with the cerebral metastasis proving fatal. This case underscores the challenges posed by advanced ACC, particularly when associated with atypical metastatic sites. Giant ACC, though rare, presents significant diagnostic and therapeutic challenges. Surgical excision with appropriate oncologic management can lead to favorable outcomes. This report contributes to the limited literature on cerebral metastases in ACC, aiming to enhance awareness among clinicians managing this rare entity.<\/jats:p>","DOI":"10.3390\/diagnostics16081143","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T07:29:29Z","timestamp":1776065369000},"page":"1143","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cerebral Metastasis in a Fatal Adrenocortical Carcinoma: A Rare Presentation of an Aggressive Tumor"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8387-8278","authenticated-orcid":false,"given":"Ach","family":"Taieb","sequence":"first","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"},{"name":"Laboratory of Exercise Physiology and Pathophysiology, L.R.19ES09, Sousse 4054, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amira","family":"Yanes","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rihab Ben","family":"Fredj","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Department of Neurosurgery, University Hospital of Sahloul Sousse, Sousse 4054, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majdouline","family":"Barkache","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Department of Neurosurgery, University Hospital of Sahloul Sousse, Sousse 4054, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2626-7313","authenticated-orcid":false,"given":"Oumaima","family":"Zarrouk","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiem","family":"Saafi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imen","family":"Halloul","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1581-3373","authenticated-orcid":false,"given":"Hamza","family":"El Fekih","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeineb","family":"Lajmi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Department of Pathology, University Hospital of Sahloul Sousse, Sousse 4054, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmine","family":"Ben Romdhane","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Department of Pathology, University Hospital of Sahloul Sousse, Sousse 4054, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghada","family":"Saad","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosra","family":"Hasni","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"636","DOI":"10.14740\/jocmr3503w","article-title":"The characteristics and trends in adrenocortical carcinoma: A United States popu-lation based study","volume":"10","author":"Sharma","year":"2018","journal-title":"J. Clin. Med. Res."},{"key":"ref_2","first-page":"e100542","article-title":"Characterization of Unilateral Adrenal Incidentalomas: Hormonal Analysis, Computed Tomography, and Magnetic Resonance Imaging Correlation","volume":"17","author":"Gasmi","year":"2025","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.mce.2013.10.028","article-title":"Genetics and epigenetics of adrenocortical tumors","volume":"386","author":"Lerario","year":"2014","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1530\/EJE-11-0679","article-title":"Adrenal involvement in MEN1. Analysis of 715 cases from the Groupe d\u2019etude des Tumeurs Endocrines database","volume":"166","author":"Chabre","year":"2012","journal-title":"Eur. J. Endocrinol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.21037\/tcr.2019.12.28","article-title":"Adrenocortical carcinoma: A literature review","volume":"9","author":"Thampi","year":"2020","journal-title":"Transl. Cancer Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"20406223211033103","DOI":"10.1177\/20406223211033103","article-title":"Adrenocortical carcinoma: Current state of the art, ongoing controversies, and future directions in diagnosis and treatment","volume":"12","author":"Shariq","year":"2021","journal-title":"Ther. Adv. Chronic Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1016\/j.annonc.2020.08.2099","article-title":"Adrenocortical carcinomas and malignant phaeochromocytomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"31","author":"Fassnacht","year":"2020","journal-title":"Ann. Oncol. Off. J. Eur. Soc. Med. 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