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Adrenocortical carcinoma (ACC) is a rare malignancy with an incidence rate of 0.5-1 per million per year. (1) Tumor thrombus in this setting has been described but it represents an exceedingly rare surgical entity. However in one retrospective ACC series was reported in 25% of cases. Similar to other ACC tumors, up to 50% of tumors with thrombus extension are functional at diagnosis. Non-functional tumors are diagnosed due to mass effect or incidentally. Depending on the tumor thrombus level, patients can present with varicocele, lower limb edema or pulmonary embolus. Apart from extension to renal vein and vena cava, extension to right atrium, splenic vein, hepatic vein(5) and invasion into vena cava have also been reported. Herein we report a case of ACC with left renal vein thrombosis in a male patient.

Adrenocortical carcinoma with renal vein tumor thrombus extension.