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

Neeraja Tillu; Jagdeesh Kulkarni

doi:10.15713/ins.bhj.97

Authors

Neeraja Tillu Consultant at Asian Cancer Institute, Mumbai
Jagdeesh Kulkarni

DOI:

https://doi.org/10.15713/ins.bhj.97

Keywords:

IVC, Adrenocortical Carcinoma, Tumour thrombus, Adrenalectomy

Abstract

Introduction
Adrenocortical 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 Report
We 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, computed
tomography, 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 regional
lymphadenectomy, ipsilateral radical nephrectomy and IVC thrombectomy.
Results And Discussion
We 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.

References

Icard P., Goudet P., Charpenay C., Andreassian B., Carnaille B., Chapuis Y. Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group. World Journal of Surgery. 2001;25(July (7)):891–897.

Ekici S., Ciancio G. Surgical management of large adrenal masses with or without thrombus extending into the inferior vena cava. Journal of Urology. 2004;172(December (6 Pt 1)):2340–2343.

Figueroa A.J., Stein J.P., Liaskovsky G., Skinner D.G. Adrenal cortical carcinoma associated with venous tumour thrombus extension. British Journal of Urology. 1997;80(September (3)):397–400.

Peix J.L., Mancini F., Villard J., Van Box Som P. Malignant cortico-adrenal tumors with vena cava extension. Is surgical resection justified? Annales de Chirurgie. 1998;52(4):357–363. [PubMed]

Turbendian H.K., Strong V.E., Hsu M., Ghossein R.A., Fahey T.J., 3rd Adrenocortical carcinoma: the influence of large vessel extension. Surgery. 2010;148(December (6)):1057–1064.

Castleman B, Scully RE, McNeely BU. Case records of the Massachusetts General Hospital. Case 46-1972. N Engl J Med 1972;287:1033-40.

Jagdeesh Kulkarni,Yogesh Jadhav, and Rohan S. Valsangkar.IVC Thrombectomy in Renal Cell Carcinoma—Analysis of Out Come Data of 100 Patients and Review of Literature. Indian J Surg Oncol. 2012 Jun; 3(2): 107–113.

Sarkar R, Eilber FR, Gelabert HA, Quinones-Baldrich WJ. Prosthetic replacement of the inferior vena cava for malignancy. J Vasc Surg 1998;28:75-83.

Bower TC, Nagorney DM, Toomey BJ, Gloviczki P, Pairolero PC, Hallett JW Jr, et al. Vena cava replacement for malignant disease; Is there a role? Ann Vasc Surg 1993;7:51-62.

Schechter DC. Cardiovascular surgery in the management of exogenous tumours involving the vena cava. In: Bergan JJ, Yao JST, editors. Surgery of the veins. Orlando: Grune & Stratton; 1985. p. 393-412.

Schramek P, Dunster E, Bhargabha A, Hruby W, Umek H. Adrenal cortical carcinoma: preoperative demonstration of right atrial extension by sonography and computerized tomography. J Urol 1985;133:260-2.

Pritchett TR, Raval JK, Benson RC, Lieskovsky G, Colletti PM, Boswell WD Jr, et al. Preoperative magnetic resonance imaging of vena caval tumour thrombi: experience with 5 cases. J Urol 1987;138:1220-2.

Falke TH, Peetoom JJ, de Roos A, van de Velde CJ, Mazer M. Gadolinium-DTPA-enhanced MR imaging of intravenous extension of adrenocortical carcinoma. J Comput Assist Tomogr 1988;12:331-4.

Tritos NA, Cushing GW, Heatley G, Libertino JA. Clinical features and prognostic factors associated with adrenocortical carcinoma: Lahey Clinic medical centre experience. Am Surg 2000;66:73-9.

Langer P, Bartsch D, Moebius E, Rothmund M, Nies C. Adrenocortical carcinoma—our experience with 11 cases. Langenbecks Arch Surg 2000;385:393-7.

Venkatesh S, Hickey RC, Sellin RV, Fernandez JF, Samaan NA. Adrenal cortical carcinoma. Cancer 1989;64:765-9.

Pommier RF, Brennan MF. An eleven-year experience with adrenocortical carcinoma. Surgery 1992;112:963-71.

Cohn K, Gottesman L, Brennan M. Adrenocortical carcinoma. Surgery 1986;100:1170-7.

Icard P, Louvel A, Chapuis Y. Survival rates and prognostic factors in adrenocortical carcinoma. World J Surg 1992;16:753-8.

Chiche L., Dousse B., Kieffer E., Chapuis Y. Adrenocortical carcinoma extending into the inferior vena cava: presentation of a 15-patient series and review of the literature. Surgery. 2006;139(January (1)):15–27.

Massimo Terzolo, MD, Martin Fassnacht, MD, Paola Perotti, PhD, Rossella Libe, MD, André Lacroix, MD, Darko Kastelan, MD, PhD, Harm Reinout Haak, MD,PhD, Wiebke Arlt, MD, Paola Loli, MD, Bénédicte Decoudier, MD, Helene Lasolle, MD, Irina Bancos, MD, Marcus Quinkler, MD, Maria Candida Barisson Villares Fragoso, PhD,MD, Letizia Canu, MD, PhD, Soraya Puglisi, MD, Matthias Kroiss, MD, Tina Dusek, MD, Isabelle Bourdeau, MD, Eric Baudin, MD, Paola Berchialla, PhD, Felix Beuschlein, MD, Jerome Yves Bertherat, MD,PhD, Alfredo Berruti, MD, Results of the ADIUVO Study, the First Randomized Trial on Adjuvant Mitotane in Adrenocortical Carcinoma Patients, Journal of the Endocrine Society, Volume 5, Issue Supplement_1, April-May 2021, Pages A166–A167.