Extension of adrenocortical carcinoma into the right atrium – echocardiographic diagnosis: A case report

Rosen, Boaz D.; Rozenman, Yoseph; Harpaz, David

doi:10.1186/1476-7120-1-5

Cited by 9 publications

(7 citation statements)

References 18 publications

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“…ACC may also extend to adjacent vasculatures such as renal veins and IVC, usually accompanied by a thrombus ( 2 - 4 ). However, intracaval invasion extending into the right atrium is very rare and several cases were reported ( 5 - 14 ). Including the case of Rosen et al ( 14 ), most of the described cases of ACC extending to RA were originated from right adrenal gland and also had tumor thrombi in IVC.…”

Section: Discussionmentioning

confidence: 99%

“…However, intracaval invasion extending into the right atrium is very rare and several cases were reported ( 5 - 14 ). Including the case of Rosen et al ( 14 ), most of the described cases of ACC extending to RA were originated from right adrenal gland and also had tumor thrombi in IVC. This finding suggest that ACC invade directly to IVC and RA.…”

Section: Discussionmentioning

confidence: 99%

“…Usual metastatic sites are the lung (71%), lymph node (68%), liver (42%), and bone (26%) ( 2 - 4 ). However, intracaval invasion extending into the right atrium is very rare and only several cases were reported ( 5 - 14 ).…”

Section: Introductionmentioning

confidence: 99%

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A Case of Non-Functioning Huge Adrenocortical Carcinoma Extending Into Inferior Vena Cava and Right Atrium

et al. 2006

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Primary adrenocortical carcinoma (ACC) is a rare tumor and its usual sites of metastasis are the lung (71%), lymph node (68%), liver (42%), and bone (26%). However, intracaval invasion extending into the right atrium is very rare and spontaneous regression of tumor burden in adrenal carcinoma is also rare. We report a case of ACC with direct invasion of the inferior vena cava and right atrium. A 34-yr-old male patient presented with progressive dyspnea, weight loss, and poor oral intake over 3 months. Non-functioning ACC with direct invasion of the inferior vena cava and right atrium was confirmed by imaging, pathologic, and hormonal study. Chemo-radio-therapy was attempted. However, tumor burden was not changed, but rather toxic hepatitis and thrombocytopenia were developed. His subjective symptoms and general conditions were improved after 1 month of conservative management and the patient was discharged. During clinical follow-up, this tumor showed spontaneous regression.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Case of Non-Functioning Huge Adrenocortical Carcinoma Extending Into Inferior Vena Cava and Right Atrium

et al. 2006

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“…Unfortunately, further work up for dyspnea revealed multiple enlarging lung nodules and massive pulmonary embolism (8 weeks after initiation of the medication). Tumor thrombus formation and venous migration through the IVC into the right atrium was demonstrated on imaging studies, and this is an exceptionally rare finding, with only few such cases being described in the literature (20).…”

Section: Discussionmentioning

confidence: 99%

Adrenocortical carcinoma and pulmonary embolism from tumoral extension

Shekhar

Gubbi

Papadakis

et al. 2019

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryAdrenococortical carcinoma (ACC) is a rare cancer, occurring at the rate of one case in two million person years. Cushing syndrome or a mixed picture of excess androgen and glucocorticoid production are the most common presentations of ACC. Other uncommon presentations include abdominal pain and adrenal incidentalomas. In the present report, a 71-year-old male presented with abdominal pain and was eventually diagnosed with ACC. He was found to have pulmonary thromboembolism following an investigation for hypoxemia, with the tumor thrombus extending upto the right atrium. This interesting case represents the unique presentation of a rare tumor, which if detected late or left untreated is associated with poor outcomes, highlighting the need for a low index of suspicion for ACC when similar presentations are encountered in clinical practice.Learning points:ACC is a rare but aggressive tumor.ACC commonly presents with rapid onset of hypercortisolism, combined hyperandrogenism and hypercortisolism, or uncommonly with compressive symptoms.Clinicians should have a low index of suspicion for ACC in patients presenting with rapid onset of symptoms related to hypercortisolism and/or hyperandrogenism.Venous thromboembolism and extension of the tumor thrombus to the right side of the heart is a very rare but serious complication of ACC that clinicans should be wary of.The increased risk of venous thromboembolism in ACC could be explained by direct tumor invasion, tumor thrombi or hypercoagulability secondary to hypercortisolism.Early diagnosis and prompt treatment can improve the long-term survival of patients with ACC.

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“…As the venous drainage of the adrenals follows the kidneys’ pathway, adrenal tumors have the propensity to extend into the IVC. However, right atrial involvement in malignant adrenal tumors is very rare ( 5 , 9 , 10 ). It is worthwhile to note that while the histopathological examination may not ascertain the primary origin of the tumor thrombus, the cells were TTF-1 positive, increasing the possibility of occult lung adenocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

Metastatic Adenocarcinoma Presenting as Extensive Cavoatrial Tumor Thrombus

et al. 2015

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The presence of tumor thrombus in the right atrium is frequently the result of direct intraluminal extension of infra-diaphragmatic malignancy into the inferior vena cava (IVC) or supradiaphragmatic carcinoma into the superior vena cava (SVC). Right atrial tumor thrombus with extension into both SVC and IVC has not been reported in the literature. We present a patient who presented with symptoms of right atrial and SVC obstruction. Imaging revealed presence of a thrombus in the right atrium, extending to the SVC and IVC, with the additional findings of a left adrenal mass and multiple liver lesions. The histopathological examination of the right atrial mass revealed metastatic adenocarcinoma cells. The patient was given a presumptive diagnosis of metastatic adenocarcinoma, most likely adrenal in origin, with multiple hepatic lesions suspicious for metastasis. The clinical outcome of the patient was not favorable; the patient succumbed before the adrenal mass could be confirmed to be the primary tumor. This case highlights that in patients manifesting with extensive cavoatrial thrombus as, the existence of primary carcinoma should be considered especially in the adrenal cortex or in the lung.

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Extension of adrenocortical carcinoma into the right atrium – echocardiographic diagnosis: A case report

Cited by 9 publications

References 18 publications

A Case of Non-Functioning Huge Adrenocortical Carcinoma Extending Into Inferior Vena Cava and Right Atrium

A Case of Non-Functioning Huge Adrenocortical Carcinoma Extending Into Inferior Vena Cava and Right Atrium

Adrenocortical carcinoma and pulmonary embolism from tumoral extension

Metastatic Adenocarcinoma Presenting as Extensive Cavoatrial Tumor Thrombus

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