A 29-year-old woman underwent surgery for resection of left adrenal cortical carcinoma in 2021. In January 2022, experienced recurrence with hepatic and lung metastases, leading to hepatectomy and thermal ablation of a pulmonary nodule. Further recurrence with lung and peritoneal disease in August 2022 prompted systemic treatment with etoposide, doxorubicin, cisplatin and mitotane. Due to progression, pembrolizumab was initiated – a major response after one year of treatment led to cytoreductive surgery with HIPEC and thermal ablation of two pulmonary nodules.

After five months, progression of lung disease was observed and the patient started on capecitabine and gemcitabine. However, nodules continued to progress, as shown in the images, with significant respiratory symptoms leading to three hospitalisations from October to December 2024, when the patient died. This is an example of a rare cancer with poor prognosis in a young patient, with lung metastases that were refractory to treatment and resulted in her death.