Right Atrial Extension of Adrenocortical Carcinoma Surgical Management Using Hypothermia and Cardiopulmonary Bypass

A patient with right adrenocortical carcinoma extending into the inferior vena cava and right atrium is presented. Tumor extension was demonstrated by magnetic resonance imaging (MRI) preoperative1 y. Successful resection of the adrenal tumor and its intravascular extension was achieved with the help of cardiopulmonary bypass and hypothermia. The patient was maintained on mitotane (o,p’-DDD), and was well for 12 months after surgery. It was concluded that intravascular extension of adrenocortical carcinoma is not a contraindication to radical surgery. Cancer 64:812-815. 1989. DRENOCORTICAL CARCINOMAS generally have poor A prognoses because of their high degree of malignancy, the late stage of the disease at diagnosis, and the lack of satisfactory adjuvant therapy. Recent studies, however, suggest that aggressive surgical therapy combined with adjuvant mitotane therapy may prolong survival even for patients with advanced disease.’ The presence of intravascular extension in an adrenocortical tumor may prevent the surgeon from proceeding with a radical resection, because of which the patient is deprived of a chance for longer survivaL2 Here we report on a patient with virilizing right adrenocortical carcinoma extending into the right atrium who underwent successful resection employing hypothermia and cardiopulmonary bypass.