Adrenocortical carcinoma with inferior vena cava, left renal vein and right atrium tumor thrombus extension

Pronio Annamaria, Piroli Silvia, Ciamberlano Bernardo, De Luca Alessandro, Marullo Antonino, Barretta Antonio, Mazzesi Giuseppe, Rossi Massimo, Chiara Montesani

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction Adrenocortical carcinoma (ACC) is a rare, but highly aggressive type of tumor with an annual incidence of 1-2 cases per million. The prognosis is poor with a five-year overall survival rate of ∼35%. The poor prognosis may be related to the advanced stage at which the majority of ACCs are detected. Complete surgical resection remains the most effective treatment. Presentation of the case A 51-year-old female patient with recent onset of dyspepsia, ascites and peripheral edema was referred to our institution. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) displayed a 8 cm ∅ right adrenal mass. Moreover a tumor thrombus jutted out into the IVC, left renal vein and right atrium. An echocardiographic evaluation confirmed the presence of the tumor thrombus in the right atrium. The patient underwent adrenalectomy with removal of its intravascular extension with the assistance of cardiopulmonary bypass and hypothermia. Discussion ACC is a rare malignancy and ACC with tumor thrombus extension is a rare presentation. Patients can present with a variety of sign and symptoms, depending on the extent of the tumor. CT scan of chest and abdomen represents the gold standard in ACC staging while magnetic resonance imaging (MRI) is preferred for tumor thrombus characterization. Complete surgical resection with a negative margin, R0 resection, is the only curative option for localized disease. Kidney sparing surgery should be performed when possible. Conclusion We present a rare case of Adrenocortical carcinoma with tumor thrombus extending into the IVC and right atrium. Complete resection with negative margins represents the best therapeutic chance for these patients.

Original languageEnglish
Article number1453
Pages (from-to)137-139
Number of pages3
JournalInternational Journal of Surgery Case Reports
Volume15
DOIs
Publication statusPublished - Jul 7 2015

Fingerprint

Adrenocortical Carcinoma
Renal Veins
Inferior Vena Cava
Heart Atria
Thrombosis
Neoplasms
Tomography
Magnetic Resonance Imaging
Dyspepsia
Adrenalectomy
Hypothermia
Cardiopulmonary Bypass
Ascites
Abdomen
Signs and Symptoms
Edema
Thorax
Survival Rate
Kidney
Incidence

Keywords

  • Adrenocortical carcinoma
  • Inferior vena cava
  • Invasion
  • Thrombus

ASJC Scopus subject areas

  • Surgery

Cite this

Adrenocortical carcinoma with inferior vena cava, left renal vein and right atrium tumor thrombus extension. / Annamaria, Pronio; Silvia, Piroli; Bernardo, Ciamberlano; Alessandro, De Luca; Antonino, Marullo; Antonio, Barretta; Giuseppe, Mazzesi; Massimo, Rossi; Montesani, Chiara.

In: International Journal of Surgery Case Reports, Vol. 15, 1453, 07.07.2015, p. 137-139.

Research output: Contribution to journalArticle

Annamaria, P, Silvia, P, Bernardo, C, Alessandro, DL, Antonino, M, Antonio, B, Giuseppe, M, Massimo, R & Montesani, C 2015, 'Adrenocortical carcinoma with inferior vena cava, left renal vein and right atrium tumor thrombus extension', International Journal of Surgery Case Reports, vol. 15, 1453, pp. 137-139. https://doi.org/10.1016/j.ijscr.2015.07.008
Annamaria, Pronio ; Silvia, Piroli ; Bernardo, Ciamberlano ; Alessandro, De Luca ; Antonino, Marullo ; Antonio, Barretta ; Giuseppe, Mazzesi ; Massimo, Rossi ; Montesani, Chiara. / Adrenocortical carcinoma with inferior vena cava, left renal vein and right atrium tumor thrombus extension. In: International Journal of Surgery Case Reports. 2015 ; Vol. 15. pp. 137-139.
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AU - Silvia, Piroli

AU - Bernardo, Ciamberlano

AU - Alessandro, De Luca

AU - Antonino, Marullo

AU - Antonio, Barretta

AU - Giuseppe, Mazzesi

AU - Massimo, Rossi

AU - Montesani, Chiara

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N2 - Introduction Adrenocortical carcinoma (ACC) is a rare, but highly aggressive type of tumor with an annual incidence of 1-2 cases per million. The prognosis is poor with a five-year overall survival rate of ∼35%. The poor prognosis may be related to the advanced stage at which the majority of ACCs are detected. Complete surgical resection remains the most effective treatment. Presentation of the case A 51-year-old female patient with recent onset of dyspepsia, ascites and peripheral edema was referred to our institution. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) displayed a 8 cm ∅ right adrenal mass. Moreover a tumor thrombus jutted out into the IVC, left renal vein and right atrium. An echocardiographic evaluation confirmed the presence of the tumor thrombus in the right atrium. The patient underwent adrenalectomy with removal of its intravascular extension with the assistance of cardiopulmonary bypass and hypothermia. Discussion ACC is a rare malignancy and ACC with tumor thrombus extension is a rare presentation. Patients can present with a variety of sign and symptoms, depending on the extent of the tumor. CT scan of chest and abdomen represents the gold standard in ACC staging while magnetic resonance imaging (MRI) is preferred for tumor thrombus characterization. Complete surgical resection with a negative margin, R0 resection, is the only curative option for localized disease. Kidney sparing surgery should be performed when possible. Conclusion We present a rare case of Adrenocortical carcinoma with tumor thrombus extending into the IVC and right atrium. Complete resection with negative margins represents the best therapeutic chance for these patients.

AB - Introduction Adrenocortical carcinoma (ACC) is a rare, but highly aggressive type of tumor with an annual incidence of 1-2 cases per million. The prognosis is poor with a five-year overall survival rate of ∼35%. The poor prognosis may be related to the advanced stage at which the majority of ACCs are detected. Complete surgical resection remains the most effective treatment. Presentation of the case A 51-year-old female patient with recent onset of dyspepsia, ascites and peripheral edema was referred to our institution. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) displayed a 8 cm ∅ right adrenal mass. Moreover a tumor thrombus jutted out into the IVC, left renal vein and right atrium. An echocardiographic evaluation confirmed the presence of the tumor thrombus in the right atrium. The patient underwent adrenalectomy with removal of its intravascular extension with the assistance of cardiopulmonary bypass and hypothermia. Discussion ACC is a rare malignancy and ACC with tumor thrombus extension is a rare presentation. Patients can present with a variety of sign and symptoms, depending on the extent of the tumor. CT scan of chest and abdomen represents the gold standard in ACC staging while magnetic resonance imaging (MRI) is preferred for tumor thrombus characterization. Complete surgical resection with a negative margin, R0 resection, is the only curative option for localized disease. Kidney sparing surgery should be performed when possible. Conclusion We present a rare case of Adrenocortical carcinoma with tumor thrombus extending into the IVC and right atrium. Complete resection with negative margins represents the best therapeutic chance for these patients.

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