Presents with paresthesias of the upper limbs for 15 days. Also presents with right upper quadrant pain. Known hypertensive with recurrent hypokalemia.
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Large, well-defined isodense lesion noted in the right suprarenal region on the non contrast series. It displaces the right kidney inferiorly. Fat planes with right kidney are well maintained.
Post contrast study shows progressive arterial enhancement with a few central non enhancing areas (likely representing areas of necrosis). Branches from the right renal artery and right inferior phrenic artery can be seen feeding the tumor. The tumor invades the inferior vena cava on the post contrast images. The infrarenal segment of the inferior vena cava is not opacified in portal venous phase.
Ultrasound guided biopsy of the right suprarenal lesion was performed:
"Microscopic features showed linear cores of tumor tissue arranged in cords, trabeculae and sheets composed of cells having pleomorphic hyperchromatic nuclei, inconspicuous nucleoli and eosinophilic to bubbly cytoplasm. Atypical mitotic figures also noted. Areas of necrosis evident."
Features suggestive of adrenocortical carcinoma.
Patient underwent right adrenalectomy with excision of tumor embolus in inferior vena cava.