Vena cava tumor thrombus from renal cell carcinoma arising from adrenal vein

Renal cell carcinoma is a highly vascular tumor with the propensity to propagate along venous channels. Vena cava tumor thrombi are reported to occur in approximately 4-10 per cent of cases and requires modification of the standard radical nephrectomy. We report the first 3 cases of vena caval tumor thrombus emanating not from the renal vein, but from the adrenal vein. The recognition of this occurrence is essential in order to avert an intraoperative catastrophe.