Spontaneous rupture of adrenocortical carcinoma: a coincidence or a tendency?

We report a rare case of adrenocortical carcinoma spontaneously rupturing. To our knowledge, this is the sixth reported case in literature that is not related to any preceding traumatic incidents or predisposing disease. Upon reviewing previous cases, tumor size greater than 10 cm in adults is a predisposing factor for spontaneous rupture, while the degree of lymph node invasion or the extent of distant metastasis is not indicative. Further study is warranted to validate our finding, but we suggest that if an adrenal tumor suspicious of malignant presentation is found incidentally, the size of tumor may warrant a more aggressive approach for prevention of tumor rupture and decrease in patient morbidity and mortality.