Adrenocortical Carcinoma With Renal Vein Thrombus Extended to Inferior Vena Cava: A Case Report

Abstract

Adrenocortical carcinoma (ACC) is a rare aggressive tumor. Renal vein and inferior vena cava (IVC) thrombi have been found as uncommon presentations of ACC; however, the implementation of comprehensive therapy has remained controversial in such cases. We report a case of a 46-year-old woman with a large ACC associated with the invasion of tumor to IVC confirmed by imaging and immunohistochemistry examinations. The patient was treated successfully using aggressive surgery, including adrenalectomy and thrombectomy adjunct to an adrenocorticolytic agent. However, she died of metastasis complications at 3-month follow-up period. ACC is a rare malignancy, mostly presenting in advanced stages with poor prognosis. Implementing aggressive surgical therapy might be effective for the management of such cases; however, the short survival duration in our case underscores the need for defining the precise therapy of metastatic ACC associated with venous invasion.

Adrenocortical Carcinoma With Cushing’s Syndrome and Extensive Tumor Thrombosis of the Inferior Vena Cava in a 30-Year-Old Filipino Female

“…There are only two cases of ACC with overt Cushing's syndrome and tumor thrombus invasion to the IVC documented in the literature. 6,10 In a literature review of 44 cases of ACC with tumor thrombus extending to the IVC, only 26 She was prepared preoperatively for the biopsy with terazosin to achieve adequate alpha blockade, increased oral fluids and liberal salt intake. A large and firm left adrenal mass with hypervascularity was noted on open biopsy (Figure 3).…”

“…CS in the setting of ACC has a negative prognostic factor because the excessive cortisol has immune were functioning tumors with a few manifesting virilization, heterosexual pseudo-precocious puberty or occult hypercortisolism demonstrable only with hormonal testing. [6][7][8][9][10] ACC is predominantly right-sided (32 rightversus 12 left-sided), usually large (range 1.8 to 25.5 cm, median 11.0 cm), with no apparent gender predominance half of cases occurring in men. [6][7][8][9][10] Tumor thrombosis, which may grow into the IVC, was more commonly found in right-compared to left-sided tumors.…”

“…[6][7][8][9][10] ACC is predominantly right-sided (32 rightversus 12 left-sided), usually large (range 1.8 to 25.5 cm, median 11.0 cm), with no apparent gender predominance half of cases occurring in men. [6][7][8][9][10] Tumor thrombosis, which may grow into the IVC, was more commonly found in right-compared to left-sided tumors. Chiche and…”

“…A margin-free complete resection provides the only means to achieve long-term survival. 2,[6][7][8][9][10][11][12][13][14][15] The presence of a tumor thrombus in the IVC and the renal vein is compatible with complete tumor resection and may need a cardiac bypass technique. 6 Unfortunately, there is no data for radical surgery with tumor thrombus invasion in the Philippines.…”

Adrenocortical carcinoma versus renal cell carcinoma with vena caval thrombus: A case report and review

“…Table 1 summarizes care reports about ACC with IVC thrombus and operation done that are available in PubMed 1‐10 . Most of the patients presented with abdominal pain or mass.…”