Metastatic Adrenocortical Carcinoma Presenting as Intracavitary Mass in Right Atrium: A Case Report

Abstract

1.1. Background: Adrenocortical carcinomas grow rapidly and tend to metastasize to liver and lungs and invade kidney, renal vein and Inferior vena cava (IVC). Cardiac metastases of the tumor is rare, less than 20 cases have been described and most of them occurred via direct extension through inferior vena cava into right atrium [1]. Endocardial Metastases from adrenocortical carcinoma presenting as an intracavitary growth in right atrium of heart without associated IVC involvement is very rare. 1.2. Case Presentation: We describe a case of 20 years old young male who presented to emergency with gradual worsening of dyspnea and facial swelling for last 6 months. Echocardiography showed a large Right atrial mass filling the whole chamber, attached to IAS (interatrial septum) via thin stalk suggestive of right atrial myxoma. Patient underwent resection of myxoma and histopathology proved it to be metastatic adrenocortical neoplasm. Whole body contrast enhanced CT scan showed primary large soft tissue mass lesion in right suprarenal location with metastatic bilateral lung metastases. On biochemical investigation associated hypercortisolemia was found. 1.3. Conclusion: Usually renal cell carcinomas spread intraluminally via inferior vena cava into the right atrium (reported in 1 % of tumors). Intracavitary presentation of metastatic adrenocortical carcinoma is very rare, and index case report was a similar presentation of a young male that underwent resection of intracavitary growth of right atrium (suspected as Myxoma), that came out to be metastatic adrenocortical carcinoma. In patients with advanced local or metastatic adrenocortical carcinomas, not amenable to surgical resection, cytotoxic chemotherapy may be attempted.