Adrenal cortical carcinoma with IVC invasion and thrombosis

Case contributed by Dr Amro Omar


Vague abdominal pain

Patient Data

Age: 45 years
Gender: Female

Abdominal ultrasound shows hyperechoic thrombus inside the IVC.

Contrast enhanced CT 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 segment 7 of the liver, although a larger adjacent hemangioma is seen in segments 7/8.

Case Discussion

The adrenal mass has an appearance which could also represent adrenal metastases or 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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