Ectopic hepatocellular carcinoma in the adrenal gland with inferior vena cava thrombosis and right atrial extension

Abstract

Intravascular tumor extension in the inferior vena cava (IVC) is known to occur with abdominal tumors, such as renal cell, hepatocellular, adrenal cell carcinoma, and Wilm's tumor. We encountered a 53‐year‐old male patient presenting with pulmonary embolism and a right atrial mass with imaging evidence of an adrenal tumor extending into the IVC, up to the right atrium. The patient underwent surgery for the resection of the tumor using cardiopulmonary bypass by a team of cardiothoracic surgeons and urologists. Histology identified the tumor as hepatocellular carcinoma, which developed as ectopic hepatic tissue in the right adrenal gland.

A large ectopic hepatocellular carcinoma with adrenal infiltration: a rare case report

“…In previous case reports, three out of 28 tumors were located in the adrenal gland, but only one of them was located in the left adrenal gland region, while this case was located in the right adrenal gland region (3,6,18). Because the tumor is located in the adrenal region, it is difficult to diagnose EHCC before surgery, and it is easy to be misdiagnosed as an adrenal tumor.…”

“…Except for one patient who did not undergo endocrine evaluation due to hemodynamic compromise and type I respiratory failure requiring emergency surgery, the other three patients underwent adrenal endocrine function evaluation. According to the test results, serum potassium, aldosterone, cortisol, and plasma metanephrines were normal, and the adrenal gland had no abnormal endocrine function (3,6,18).…”

“…It is reported that the incidence of ectopic liver during laparoscopy or autopsy ranges from 0.24% to 0.47% ( 2 ). Ectopic liver can be located in various organs or tissues near the liver, such as gallbladder, adrenal gland, pancreas, peritoneum and thorax ( 3 – 6 ). Due to the variable location, the clinical signs of EHCC are still not fully elucidated.…”

Ectopic hepatocellular carcinoma in the adrenal gland with inferior vena cava thrombosis and right atrial extension

“…Filippos‐Paschalis R et al 1 described a very interesting and unique case of ectopic hepatocellular carcinoma (HCC) in the adrenal gland with inferior vena cava (IVC) thrombosis and right atrial extension. The patient developed respiratory failure and required an urgent operation.…”

“…The use of CPB with or without a hypothermic circulatory arrest is indicated in cases like the one described by Filippos‐Paschalis et al 1 The tumor was probably too bulky to be removed without the use of CBP; otherwise, the risk of developing postoperative coagulopathy and neurological sequelae with the use of CBP and hypothermic circulatory arrest, respectively, may be high and should be used with caution. There are select cases of RCC and adrenal HCC with tumor thrombus extension which can be removed safely from the right atrium and IVC without the use of CPB 2,7,8 .…”