Abstract
This is a case presentation of a large locally advanced adrenocortical carcinoma that is used to exhibit the step-by-step approach to open right adrenalectomy. The patient is a 65-year-old male who presented to a community hospital in May 2015 with abdominal pain, weight loss, and early satiety. A large right retroperitoneal mass was identified on CT, and core biopsy revealed adrenocortical carcinoma. Initial surgical evaluation deemed the tumor unresectable. Chemotherapy was initiated on December 2015 after referral to a tertiary care center. He was admitted to Montefiore Medical Center for neutropenic fever in March 2016 and was subsequently referred to endocrine surgery. CT obtained to assess for resectability and restaging revealed the known mass measuring 19.5 × 24 × 15.5 cm with central necrosis and metastases to pericaval lymph nodes. The inferior vena cava (IVC) was compressed without clear evidence of invasion, and there was no invasion of the liver. Whole body PET CT was negative for distant metastases. Surgery was coordinated with a hepatobiliary surgeon for possible hepatectomy and IVC replacement and a cardiac surgeon for possible cardiopulmonary bypass or circulatory arrest. Upon exploration, there was no IVC invasion, no tumor thrombus in the IVC, and the tumor was resected en bloc with the kidney. Pathology report revealed adrenocortical carcinoma, 27 × 17 × 9 cm, with invasion into periadrenal and renal adipose tissue, and lymphovascular invasion. Despite significant time between initial diagnosis and surgical resection, this patient with a locally advanced tumor did not develop metastatic disease, making surgery a safe option with proper planning.
Source: A patient of Dr. Amanda Laird while she was employed at Montefiore Medical Center; there were no conflicts of interest of obligations to the patient resulting from this case presentation
The authors have no commercial associations relevant to this case presentation
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Runtime of video: 10 mins 17 secs
Previously presented at the ACS Clinical Congress in San Diego, CA on October 24, 2017 as a video podium presentation.
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