Adrenal cortical carcinoma (presumably) with IVC invasion and thrombosis

Case contributed by Dr Amro Omar

Presentation

Vague abdominal pain

Patient Data

Age: 45
Gender: Female

Abdominal ultrasound shows hyperechoic thrombus inside the IVC.

CECT shows a large right adrenal mass with small areas of necrosis. There is no macrocalcification in the adrenal mass. There is invasion of the IVC, with tumor thrombus in the suprahepatic IVC. There is suspected local extension to segments 7 of the liver. A large hemangioma is seen in segment 7 of the liver.

Case Discussion

The adrenal mass has an appearance the could also be seen with adrenal metastases and pheochromocytoma . However, the large size at presentation, the absence of functional activity, the invasion of the IVC, and the unilaterality, all favor adrenal cortical carcinoma.

Most adrenal carcinomas are >5 cm at presentation and may either be functioning or "silent". Some surgeons prefer not to biopsy large primary adrenal tumors due to a theoretical risk of tumor seeding.

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Case Information

rID: 34307
Case created: 13th Feb 2015
Last edited: 1st Oct 2015
Inclusion in quiz mode: Included

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