Adrenocortical carcinoma with renal vein invasion in a woman with a horseshoe kidney.
F s F s r shown) 31 year old woman presented with new onset hypertension. After inadequate control with edications and one episode of urgent hypertenion, computed tomography of the abdomen was erformed. A large left sided adrenal mass, with a lling defect in the renal vein, in addition to a orseshoe kidney was discovered (Fig. 1) On physical examination, she was hirsute, but ithout signs of hypercortisolism or virilization. er workup yielded an elevated 17 ketosteroid nd dehydroepiandrosterone level. A working dignosis of left sided adrenocortical carcinoma was ade, and additional imaging was performed to valuate for possible venous invasion before proeeding to surgical removal. Computed tomography angiography of the abomen, with special attention to the inferior ena cava, demonstrated a large left adrenal mass ith 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 to ny adjacent structures, and the horseshoe kidney as not involved. At last follow up, she was receivng chemotherapy. Adrenocortical carcinoma is a rare endocrine alignancy, with an annual incidence of less than cases per million.1,2 The reported incidence of horseshoe kidney is 0.25% or about 1 in 400 eople.3 This is the first documented case of an
Urology