title: [Carcinoma of the pararenal gland infiltrating the surrounding tissue and involving the inferior vena cava].
abstract: ▼HISTORY AND ADMISSION FI NDINGS: 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 exstirpation of the intracaval tumour thrombus (by cavotomy under digital occlusion of the blood flow from the vena cava into the right atrium - cardiac surgeon) was carried out with no significant postoperative complications. Subsequently, the patient underwent adjuvant mitotane therapy for 3 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 pararenal gland carcinoma.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R.
authors.forename: J
authors.initials: J
authors.lastname: Dillner
authors.forename: F
authors.initials: F
authors.lastname: Meyer
authors.forename: H
authors.initials: H
authors.lastname: Lippert
authors.forename: C
authors.initials: C
authors.lastname: Huth
authors.forename: S
authors.initials: S
authors.lastname: Klose
authors.forename: A
authors.initials: A
authors.lastname: Roessner
authors.forename: Z
authors.initials: Z
authors.lastname: Halloul
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods; D000792:Angiography; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D003937:Diagnosis, Differential; D017128:Embolectomy / Q000379:methods; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008197:Lymph Node Excision; D008875:Middle Aged; D008939:Mitotane / Q000009:adverse effects / Q000627:therapeutic use; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D011379:Prognosis; D012077:Renal Artery / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000473:pathology* / Q000601:surgery*
chemical_list: D008939:Mitotane