adrenocortical carcinoma with renal vein invasion in a woman with a horseshoe kidney
TRANSCRIPT
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IMAGES IN CLINICAL UROLOGY
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ADRENOCORTICAL CARCINOMA WITH RENAL VEININVASION IN A WOMAN WITH A HORSESHOE KIDNEY
MICHAEL A. WHITE AND KENNETH SHOCKLEY
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31-year-old woman presented with new-onsethypertension. After inadequate control with
edications and one episode of urgent hyperten-ion, computed tomography of the abdomen waserformed. A large left-sided adrenal mass, with alling defect in the renal vein, in addition to aorseshoe kidney was discovered (Fig. 1).On physical examination, she was hirsute, butithout signs of hypercortisolism or virilization.er workup yielded an elevated 17 ketosteroid
nd dehydroepiandrosterone level. A working di-gnosis of left-sided adrenocortical carcinoma wasade, and additional imaging was performed to
valuate for possible venous invasion before pro-eeding to surgical removal.Computed tomography angiography of the ab-
omen, with special attention to the inferiorena cava, demonstrated a large left adrenal massith a filling defect seen within the renal vein to
he level of its insertion at the inferior vena cava.nce again, a horseshoe kidney was visualized
Fig. 2).The patient underwent surgical removal by way
f a chevron incision. The mass did not adhere tony adjacent structures, and the horseshoe kidneyas not involved. At last follow-up, she was receiv-
ng chemotherapy.Adrenocortical carcinoma is a rare endocrinealignancy, with an annual incidence of less thancases per million.1,2 The reported incidence ofhorseshoe kidney is 0.25%, or about 1 in 400eople.3 This is the first documented case of an
rom the Michigan State University-College of Osteopathic Med-cine Urologic Consortium, Metro Health Hospital of Grand Rap-ds, Grand Rapids, Michigan
Reprint requests: Michael A. White, D.O., Department of Urol-gy, Michigan State University-College of Osteopathic Medicinerologic Consortium, Metro Health Hospital of Grand Rapids,919 Boston Southeast, Grand Rapids, MI 49506. E-mail:[email protected]: February 26, 2006, accepted (with revisions): June
, 2006 t
2006 ELSEVIER INC. ULL RIGHTS RESERVED
IGURE 2. Computed tomography angiography scanhowing left-sided adrenal mass with tumor thrombus ex-
IGURE 1. Computed tomography scan showing left-ided adrenal mass with tumor thrombus extending intoenal vein. Caudad to mass is horseshoe kidney (not
ending into left renal vein; horseshoe kidney is caudad.
ROLOGY 68: 1119–1120, 2006 • 0090-4295/06/$32.00doi:10.1016/j.urology.2006.06.005 1119
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drenocortical carcinoma discovered in conjunc-ion with a horseshoe kidney.
REFERENCES1. Brennan MF: Adrenocortical carcinoma. Cancer 37:
48–365, 1987. 1
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2. National Cancer Institute: Third National Cancer Surveyncidence Data. Bethesda, National Cancer Institute, 1975, pp85–787.3. Bauer SB: Anomalies of the upper urinary tract, inalsh PC, Retik AB, Vaughan ED, et al (Eds): Campbell’s
rology, 8th ed. Philadelphia, WB Saunders, 2002, pp
885–1924.UROLOGY 68 (5), 2006