Table of Contents    
Case Report
 
Adrenal cortical carcinoma with pulmonary emboli: A unique presentation of a rare tumor with extensive tumor thrombus and inferior vena cava extension
Hoylan T. Fernandez1, Peter T. W. Kim1, Giuliano Testa1
1MD, From the Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas.

Article ID: 100051IJHPDHF2016
doi:10.5348/ijhpd-2016-51-CR-7

Address correspondence to:
Hoylan T. Fernandez
MD, Annette C. and Harold C. Simmons Transplant Institute
Baylor University Medical Center
3500 Gaston Avenue, Dallas, TX 75246
United States

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How to cite this article:
Fernandez HT, Kim PTW, Testa G. Adrenal cortical carcinoma with pulmonary emboli: A unique presentation of a rare tumor with extensive tumor thrombus and inferior vena cava extension. Int J Hepatobiliary Pancreat Dis 2016;6:30–33.


Abstract
Introduction: Adrenal cortical carcinoma (ACC) is rare, and presenting symptoms vary widely depending on functional or non-functional endocrine status. These tumors are most commonly treated with surgical resection and postoperative mitotane administration.
Case Report: This is an unusual presentation of a 23- year-old female with no significant past medical history, admitted to the hospital with syncope and dyspnea. Computed tomography angiography (CTA) demonstrated extensive bilateral pulmonary embolisms, with an associated 16-cm assumed right lobe hepatic mass with suprahepatic vena cava tumor thrombus extension beyond the level of the hepatic veins. The patient underwent a complete resection of the right adrenal mass, with inferior vena cava resection, thrombectomy, and placement of caval interposition graft without the use of bypass. Pathology was consistent with adrenal cortical carcinoma.
Conclusion: This case of an adrenal cortical carcinoma, with a rare presentation of bilateral pulmonary embolisms, was treated with a surgical R0 resection. This included a right adrenalectomy with IVC resection and interposition graft. Tumors with IVC involvement and tumor thrombus can be treated with surgical resection and IVC grafting, without the use of bypass.

Keywords: Adrenalectomy, Adrenal cortical carcinoma, Inferior vena cava


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Author Contributions
Hoylan T. Fernandez – Substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, drafting the article, revising it critically for important intellectual content, final approval of the version to be published
Peter T. W. Kim –Analysis and interpretation of data, revising it critically for important intellectual content, final approval of the version to be published
Giuliano Testa – Analysis and interpretation of data, revising it critically for important intellectual content, final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Hoylan T. Fernandez et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.