IVC thrombectomy in a patient with adrenal tumour with IVC thrombus.

Abstract

IntroductionAdrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis, and the association with tumour thrombus into the inferior vena cava (IVC) is infrequent. Radical surgery is the best treatment.Case ReportWe herein report a case of a large ACC of the left adrenal gland extending into the IVC through the left renal vein in a 68-year-old male patient. He presented with pain in the left side of the abdomen for one month and significant weight loss (7 kilograms). On examination, a hard irregular non-ballotable lump was palpable in the left lumbar region. Ultrasonography, computedtomography, and whole-body PET CT all revealed a large mass over the upper pole of the left kidney with tumour thrombus in the IVC. Laboratory tests showed creatinine levels of 0.9 mg/dl (normal range: 0.5–1.2 mg/dl) while plasma levels of cortisol, free metanephrines were normal. A midline laparotomy was performed, and the tumour was completely excised with regionallymphadenectomy, ipsilateral radical nephrectomy and IVC thrombectomy.Results And DiscussionWe emphasize that adrenal cortical carcinoma is a rare tumour and can have tumour thrombi invading the IVC. Such cases do not represent a contraindication to surgery, and we suggest radical surgical removal of cancer with the thrombus.