J.Jpn. Surg. Soc.. 88(2): 231-238, 1987

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Case report

SURGICAL RESECTION OF ADRENAL CARCINOMA EXTENDING INTO THE VENA CAVA, RIGHT ATRIUM AND VENTRICLE : A CASE REPORT AND REVIEW OF THE LITERATURE

A case of adrenal carcinoma with the tumor thrombus extending into the right atrium and right ventricle is reported. A 46-year-old man was admitted bacause of abdominal distention and back pain. Angiogram, venacavography, dynamic CT, cardio-echogram and determinations of blood concentration of hormones disclosed a huge non-functional right adrenal tumor and its thrombus having extended into the right atrium and ventricle via the right adrenal vein. Right adrenectomy and nephrectomy were followed by simultaneous removal of the tumor thrombus. The resected tumor was 14×11×7cm in size and 880g. The thrombus was 90g. Pathohistological diagnosis of sarcomatoid adrenocortical carcinoma was made. The patient was discharged three weeks after operation and had been remained asymptomatic for 5 months. He died of the recurrence of the tumor on the 206th post operative day.
In the review of English and Japanese literature, 61 cases of malignant tumors extending into the right atrium was analized, among which only one case was an adrenal tumor. From this survey, it seems that aggressive resection would provide better survival, and a surgical excision with a use of cardiopulmonary bypass is worth trying for such conditions.

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