We report a case of right adrenal cortical carcinoma with tumor thrombus in the inferior vena cava (IVC), which was safely resected.
A 50-year-old woman was referred to our hospital for investigation of a right adrenal tumor, 13cm in diameter, with extension to the IVC. Preparing an artificial heart-lung machine, radical surgery, including resection of the tumor, part of the right liver lobe, and tumor thrombus in the IVC was performed. Surgery was safely performed without the aid of cardiopulmonary bypass. This was because we used intraoperative transesophageal echocardiographic evaluation, which was able to confirm whether tumor invasion extended into the right atrium, and to detect the resection range of the IVC. Surgical resection was completed as usual without complications ; the postoperative course was uneventful and the patient was discharged on postoperative day 16 with asymptomatic pulmonary thromboembolism. The patient was treated with mitotane (o,p'-DDD), which resulted in necrosis of the adrenocortical tumor. The patient was alive 9 months after surgery.