Adrenocortical carcinoma with inferior vena cava tumour thrombus: multidetector CT (MDCT) evaluation and management
Priyank Yadav,1 Sohrab Arora,1 Devarshi Srivastava,1 Hira Lal2
1Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India 2Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Correspondence to Dr Priyank Yadav, priyankmamc@gmail.com
Accepted 19 November 2015
DESCRIPTION
A 58-year-old man, a farmer, who was a known hypertensive poorly controlled on metoprolol, amlodipine and enalapril, presented with sweating and giddiness for 10 months and pedal oedema for 3 months. On ultrasonography, a heteroechoic mass was found near the upper pole of his left kidney. Multidetector CT of the abdomen showed an 11×8×5 cm heterogeneous mass arising from the left adrenal gland, with an attenuation of 28 HU on non-contrast CT and 35% absolute washout on delayed film. The venous thrombus extended from left adrenal vein into the infradiaphragmatic infer- ior vena cava (IVC), extending 2.5 cm above the hepatic vein confluence (figures 1 and 2). Urinary normetanephrines were 889 µg/24 h, urinary meta- nephrine was 107 µg/24 h and serum cortisol level was 800 nmol/L. The patient underwent left open adrenalectomy with IVC thrombectomy. At 2-year follow-up, he was normotensive without any signs of residual/recurrent disease.
Adrenocortical carcinoma is infrequently asso- ciated with venous tumour thrombus (2.9%).1 Venous involvement occurs earlier in right-sided tumours due to the renal vein on the left side. CT washout studies are the gold standard for differen- tiating adenoma from carcinoma, the former sug- gested by absolute percentage washout >60% or relative percentage washout >40%. Hypersecretion of adrenal hormones is found in 50-80% of patients, the most common being cortisol. Catecholamines are typically normal, although false elevation is seen with use of ß-blockers to control hypertension.2
CrossMark
To cite: Yadav P, Arora S, Srivastava D, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015- 213073
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With IVC tumour thrombus, survival is 25% at 5 years in absence of metastatic disease and only 20% at 2 years in presence of metastasis.3
Learning points
Adrenocortical carcinoma is a rare cause of inferior vena cava (IVC) tumour thrombus.
Management of IVC tumour thrombus is similar to that for renal cell carcinoma.
Despite aggressive surgical efforts, prognosis is dismal.
Twitter Follow Sohrab Arora at @drsohrab Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES
1 Osman Y, Haraz A, El-Mekresh M, et al. Adrenal tumors with venous thrombosis: a single-institution experience. Urol Int 2011;87:182-5.
2 Eisenhofer G, Goldstein DS, Walther MM, et al. Biochemical diagnosis of pheochromocytoma: how to distinguish true- from false-positive test results. J Clin Endocrinol Metab 2003;88: 2656-66.
3 Icard P, Goudet P, Charpenay C, et al. Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group. World J Surg 2001;25:891-7.
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BMJ Case Reports: first published as 10.1136/bcr-2015-213073 on 1 December 2015. Downloaded from http://casereports.bmj.com/ on 5 April 2026 at National Library of Medicine.