Vena Cava ınvasion by Adrenal Leiomyosarcoma

Primary adrenal mesenchymal tumors are extremely rare. These tumors are hard to diagnose, and similar to certain adrenal tumors, as they do not produce hormones, and they can only manifest themselves when the tumor reaches an advanced size. These tumors are generally detected incidentally. This study reports a rare case of primary leiomyosarcoma of the right adrenal gland with vena cava invasion, in a 70-year-old woman who presented with right flank pain. Computerized tomography showed an adrenal mass with a diameter of 78 mm, which exerted pressure on the vena cava inferior. The invasive part was excised by using adrenalectomy and cavatomy. Tumor invasion was determined on the wall of the vena cava. Histopathological examination on 10× magnification showed 8-10 mitotic events. Immunohistochemical staining showed that the cells were SMA (+), desmin (+), cytokeratin (-), and Bcl-2 (-). The Ki67 proliferation index was 70%. Widespread metastasis developed six months after the adrenalectomy.