Extension of Adrenocortical Carcinoma into the Right Atrium

Abstract

Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignant neoplasm which can produce intravascular extension into the inferior vena cava (IVC) rarely extend into the right atrium (RA). We report a case of a male patient with large ACC with extension into the IVC and RA. Computed tomography showed a large right adrenal mass with contiguous tumor thrombus extending into IVC and RA with extension to the level of tricuspid valve. Patient underwent combined cardiac and abdominal surgical intervention on cardiopulmonary bypass with removal of the mass.

Keywords: Adrenocortical Carcinoma; Right Atrium.

Fig.1

Fig.1A: Computed tomography (coronal view) shows a large, heterogeneous and lobulated mass arising from the right adrenal gland, measuring 10 cm x 12 cm x 22 cm, which extends into the inferior vena cava and right atrium. Fig.1B: Computed tomography (axial view) reveals a filling defect caused by the tumor which occupies the entire right atrium to the level of tricuspid valve. RA = right atrium Fig.1C: Transthoracic echocardiogram (apical 4 chamber zoomed-in view) of the right atrial mass prolapsing through the tricuspid valve into the right ventricle. RA = right atrium; RV = right ventricle. Fig.1D: Transesophageal echocardiogram (mid esophageal 4 chamber view) showing the right atrial mass prolapsing through the tricuspid valve in to the right ventricle. RA = right atrium; RV = right ventricle. Fig.1E: Intraoperative photograph of the right atrial mass.