[Organ-invasive carcinoma of the pararenal gland involving the inferior vena cava: successful curative and interdisciplinary surgical management].
METHODS
A 61-year-old woman presented with a 2-month-history of progressive deterioration, increasing exertional dyspnoea and pain in the right upper abdomen (past medical history: bronchial asthma and hypertension). The physical examination showed mild generalized weakness, tenderness in the right upper abdomen, and ascites.


METHODS
Laboratory studies did not reveal any hormonal abnormalities. A CT angiogram revealed a mass of the right adrenal gland with distinct invasion into the inferior vena cava, and tumour thrombosis that extended proximally into the right atrium. Distally, the tumour ended at the caudate lobe of the liver with an extensive peripherally engulfed thrombus from the inferior vena cava down to the common iliac veins.


METHODS
An open right adrenalectomy with resection of the periadrenal tissue and extirpation of the intracaval tumour thrombus (by cavotomy under digital occlusion of the blood flow from the vena cava into the right atrium) was carried out with no significant postoperative complications. Subsequently, the patient underwent adjuvant mitotane therapy for three years. So far, no recurrence has occurred during a course of 7 years.


CONCLUSIONS
Tumour induced thrombotic occlusion of the inferior vena cava and other veins is rare, especially with right atrium involvement. In the absence of other effective treatment options, the combination of radical resection and adjuvant mitotane therapy remains the only successful curative treatment for primary invasive adrenal gland carcinoma.
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R.
J
J
Dillner
F
F
Meyer
H
H
Lippert
C
C
Huth
S
S
Klose
A
A
Roessner
Z
Z
Halloul
D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology*; D006503:Hepatic Veins / Q000473:pathology; D006801:Humans; D007084:Iliac Vein / Q000473:pathology; D033183:Interdisciplinary Communication; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D013927:Thrombosis / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000473:pathology* / Q000601:surgery