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ADRENOCORTICAL CARCINOMA WITH RENAL VEIN INVASION IN A WOMAN WITH A HORSESHOE KIDNEY
MICHAEL A. WHITE AND KENNETH SHOCKLEY
A 31-year-old woman presented with new-onset hypertension. After inadequate control with medications and one episode of urgent hyperten- sion, computed tomography of the abdomen was performed. A large left-sided adrenal mass, with a filling defect in the renal vein, in addition to a horseshoe kidney was discovered (Fig. 1).
On physical examination, she was hirsute, but without signs of hypercortisolism or virilization. Her workup yielded an elevated 17 ketosteroid and dehydroepiandrosterone level. A working di- agnosis of left-sided adrenocortical carcinoma was made, and additional imaging was performed to evaluate for possible venous invasion before pro- ceeding to surgical removal.
Computed tomography angiography of the ab- domen, with special attention to the inferior vena cava, demonstrated a large left adrenal mass with a filling defect seen within the renal vein to the level of its insertion at the inferior vena cava. Once again, a horseshoe kidney was visualized (Fig. 2).
The patient underwent surgical removal by way of a chevron incision. The mass did not adhere to any adjacent structures, and the horseshoe kidney was not involved. At last follow-up, she was receiv- ing chemotherapy.
Adrenocortical carcinoma is a rare endocrine malignancy, with an annual incidence of less than 2 cases per million.1,2 The reported incidence of a horseshoe kidney is 0.25%, or about 1 in 400 people.3 This is the first documented case of an
Reprint requests: Michael A. White, D.O., Department of Urol- ogy, Michigan State University-College of Osteopathic Medicine Urologic Consortium, Metro Health Hospital of Grand Rapids, 1919 Boston Southeast, Grand Rapids, MI 49506. E-mail: mikeawhite@sbcglobal.net
Submitted: February 26, 2006, accepted (with revisions): June 1, 2006
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| adrenocortical carcinoma discovered in conjunc- tion with a horseshoe kidney. | 2. National Cancer Institute: Third National Cancer Survey Incidence Data. Bethesda, National Cancer Institute, 1975, pp 785-787. 3. Bauer SB: Anomalies of the upper urinary tract, in |
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| REFERENCES | Walsh PC, Retik AB, Vaughan ED, et al (Eds): Campbell's |
| 1. Brennan MF: Adrenocortical carcinoma. Cancer 37: 348-365, 1987. | Urology, 8th ed. Philadelphia, WB Saunders, 2002, pp 1885-1924. |