From October 2017 to March 2019, a total of 8 cases of massive adrenal area
tumor (>7 cm) with venous
tumor thrombus were admitted at Peking University Third Hospital including 5 males and 3 females with mean age 50.6 years (31-62 years). There were 6 cases on the right side and 2 cases on the left side. The first symptoms included abdominal discomfort,
hypertension,
Cushing syndrome and abnormal menstruation; special past history included
cirrhosis and
lung cancer. Computed tomography (CT) and routine endocrine
hormone tests were examined. Preoperative imaging confirmed 5 cases masses with
tumor thrombus in inferior vena cava (IVC) and 1 case with
tumor thrombus in left renal vein. Two cases presented with
tumor thrombus in central adrenal vein were found intraoperatively. Open
adrenalectomy and
thrombectomy were performed in 4 cases of right side complicated with high
tumor thrombus of inferior vena cava. Laparoscopic
adrenalectomy and
thrombectomy were performed in 3 cases, including 2 cases on the right and 1 case on the left. The case with
tumor thrombus in left renal vein gave up operation. The patients were followed up with outpatient and telephone.
RESULTS: CONCLUSION: We present the rare cases of different pathological types of massive adrenal
tumors with
tumor thrombus extending into the IVC extension or other vein. Preoperative diagnosis needs comprehensive evaluation and perfect preoperative preparation. Surgery is difficult and varied. Open approach as well as retroperitoneal laparoscopic approach is feasible.