Coincidence of primary adrenocortical carcinoma and melanoma: three CASE reports.

BACKGROUND: Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with a heterogeneous prognosis, while adrenal metastasis from other primary cancers, including melanoma, may occur more frequently. ACC may rarely occur as part of familial cancer syndromes, but even in sporadic cases, a significant proportion of patients had other malignancies before or after diagnosis of ACC. Herein we present three cases where sporadic ACC was identified in patients with coexistent or previous history of melanoma. CASE DESCRIPTION: Patient 1 - A 37-yr-old man with a superficial spreading BRAF-positive melanoma was found to harbour a progressively growing left adrenal mass. Initially, he was suspected of having adrenal metastasis, but the histology after adrenalectomy confirmed ACC. Patient 2 - A 68-year-old man with a history of recurrent BRAF-positive melanoma was diagnosed with disseminated metastatic melanoma recurrence, including a rapidly enlarging left adrenal mass. Consequently, he underwent left adrenalectomy, and histology again confirmed ACC. Patient 3 - A 50-yr-old man was referred with histological diagnosis of metastatic ACC. He had a background history of pT1 melanoma. We undertook targeted sequencing of ACC tissue samples in all cases. Somatic variants were observed in the known driver genes CTNNB1 (Patient 1), APC and KMT2D (Patient 2), and APC and TP53 (Patient 3). Germline TP53 variants (Li-Fraumeni syndrome) were excluded in all cases. Retrospective review of our patient cohort in the last 21 years revealed a frequency of 0.5% of histologically diagnosed melanoma metastasis among patients referred for adrenal masses. On the other hand, 1.6% of patients with histologically confirmed ACC had a previous history of melanoma. CONCLUSION: Sporadic ACC can occur in the background of melanoma, even if adrenal metastasis might appear to be the most likely diagnosis. Coexistent primary adrenal malignancy should be considered and investigated for in all patients with a history of melanoma with suspicious adrenal lesions.

Partner-Support and Gestational Duration Among Pregnant Women Who Smoke.

INTRODUCTION: Pregnant women who smoke are at a high risk of preterm birth (PTB) and have low partner-support. In a prospective cohort study, we aimed to examine the role of partner-support in gestational duration and PTB among pregnant women who smoke as well as the interaction with race/ethnicity. METHODS: We analyzed secondary data of 53 participants from the University at Buffalo Pregnancy and Smoking Cessation Study. Partner-support was measured with Turner's support scale where women reported how much they agreed with five statements about how supportive their partner was. Total partner-support was calculated and split into emotional support and accountability. We fit multivariable linear regression models and log-binomial regression models for gestational duration and PTB, respectively. RESULTS: Gestational duration significantly increased with partner-support (0.22 weeks longer per unit increment in partner-support score), emotional support (0.52 weeks), and accountability (0.35 weeks). This association tended to be stronger among Hispanics and women of other races than non-Hispanic Caucasians and African Americans. Women with a bed partner had 1.48 weeks longer gestational duration than women without a bed partner. DISCUSSION: Partner-support may increase gestational duration and reduce PTB risk among pregnant women who smoke, especially among Hispanic women. Sharing a bed with a partner was associated with a longer gestational duration. Our findings may be interpreted with caution due to limitations such as small sample size, recruitment within a single metropolitan area, and partner-support measurement via maternal reports only. A partner-support intervention to increase gestational duration is warranted.

Partner-support might help increase gestational duration and possibly reduce risk of preterm birth, and future research is needed to replicate our findings in larger samples. Pregnant women who smoke are at a high risk for short gestational duration and preterm birth (PTB) and have low partner-support. Previous research did not address the potential racial/ethnic differences in the influence of partner-support on PTB. We found partner-support might increase gestational duration and possibly reduce PTB risk among pregnant women who smoke. The association between partner-support and gestational duration tended to be stronger among Hispanics and women of other races than Non-Hispanic Caucasians and African Americans.