Inferior vena caval involvement by adrenal cortical carcinoma

A case of preoperative demonstration of inferior vena caval extension of tumor thrombus from adrenal cortical carcinoma is presented. Surgery showed that extension had occurred via the adrenal vein rather than by direct invasion. A search of the literature failed to uncover either any mention of preoperative attention to the possibility of caval involvement or of this particular mode of extension. Review of our experience with 17 adrenal cortical carcinomas suggested that carcinoma of the right adrenal gland involves the vena cava more commonly than does carcinoma of the left. We recommend that cavography be performed in the evaluation of adrenal carcinoma.