Okazumi S, Asano T, Ryu M, Nagashima T, Odaka M, Isono K, Nishizawa T
Nihon Geka Gakkai Zasshi. 1987 Feb;88(2):231-8.
A case of adrenal carcinoma with the tumor thrombus extending into the right atrium and right ventricle is reported. A 46-year-old man was admitted because of abdominal distention and back pain. Angiogram, venacavography, dynamic CT, cardio-echogram and determinations of blood concentration of hormones disclosed a huge non-functional right adrenal tumor and its thrombus having extended into the right atrium and ventricle via the right adrenal vein. Right adrenalectomy and nephrectomy were followed by simultaneous removal of the tumor thrombus. The resected tumor was 14 X 11 X 7 cm in size and 880 g. The thrombus was 90 g. Pathohistological diagnosis of sarcomatoid adrenocortical carcinoma was made. The patient was discharged three weeks after operation and had been remained asymptomatic for 5 months. He died of the recurrence of the tumor on the 206th postoperative day. In the review of English and Japanese literature, 61 cases of malignant tumors extending into the right atrium were analyzed, among which only one case was an adrenal tumor. From this survey, it seems that aggressive resection would provide better survival, and a surgical excision with a use of cardiopulmonary bypass is worth trying for such conditions.
报告一例肾上腺癌伴肿瘤血栓延伸至右心房和右心室。一名46岁男性因腹胀和背痛入院。血管造影、腔静脉造影、动态CT、心脏超声检查以及激素血浓度测定显示，右侧肾上腺有一个巨大的无功能肿瘤，其血栓经右肾上腺静脉延伸至右心房和心室。行右肾上腺切除术和肾切除术后，同时切除肿瘤血栓。切除的肿瘤大小为14×11×7cm，重880g。血栓重90g。病理组织学诊断为肉瘤样肾上腺皮质癌。患者术后三周出院，5个月来一直无症状。术后第206天死于肿瘤复发。在回顾英文和日文文献时，分析了61例肿瘤延伸至右心房的病例，其中只有1例是肾上腺肿瘤。从这项调查来看，积极切除似乎能提高生存率，对于这种情况，使用体外循环进行手术切除值得一试。
