Adrenocortical carcinomas (ACCs) are rare and aggressive tumors that may be functional causing Cushing 's syndrome and/or virilization or nonfunctional presenting as abdominal mass or as an incidental finding.

We present a case of a 49-year-old woman who presented with menstrual irregularities, hirsutism and virilising symptoms.Laboratory work up revealed elevated serum androgens, 9.8 nmol/L testosterone and 5,20 ng/ml androstenedione , with nearly normal DHEAS. The abdominal scan showed left adrenal mass, diameter 5.5x5.0x4.9 centimetres, with 36HU (Hounsfield Units) density and absolute washout 60%. These findings suggested ACC.

A left laparoscopic adrenalectomy in a lateral decubitus position was performed . The tutor was resected radically with safe oncological margins and without capsule rupture. The ligation of the vessels was achieved with clips and harmonic scissors. The specimen was placed in a special bag and was extracted integral , through minimal extension of the initial incision of the first port. Frozen section of five circumferential margins of the specimen were negative for local infiltration. The postoperative course was uneventful. The histopathological findings confirmed the diagnosis of Adrenocortical carcinoma with Weiss score3, Helsinki score 28 and Ki-67 : 20%. The dimensions of the tumor were 9x5.5x5 centimetres larger than that of the initial study.

Laparoscopic adrenalectomy can be safely performed in Adrenocortical carcinomas larger than 6 centimetres only if the principles of oncological resection can be ensured.