右側腎上腺平滑肌肉瘤併下腔靜脈及右心房侵犯
賴宗豪、林克勳
台北醫學大學市立萬芳醫院 泌尿科
Right adrenal leiomyosarcoma extending into inferior vena cava and right atrium
Benjamin Lai Chung Howe, Ke-Hsun Lin
Department of Urology, Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

 

Leiomyosarcomas(LMS) are rare and typically originates from smooth muscle cells. Primary adrenal LMS is even more rare and aggressive. Due to direct venous drainage into inferior vena cava(IVC), right adrenal tumors may even invade the IVC and toward the right atrium. Herein, we present a case of a 59-year-old lady suffering from a right adrenal LMS extending into the IVC and right atrium. She presented with right upper quadrant abdominal dull pain for 1.5 years. Computed tomography revealed a right adrenal heterogeneous mass, measuring 4.8cm, with involvement of the IVC, right atrium tumor thrombus, and suspected liver invasion. Right adrenalectomy with vena caval and right atrium thrombectomy was undergone under hypothermic cardiopulmonary bypass. Microscopic examination showed spindle tumor cells arranged in fascicles and immunohistochemically positive for vimentin, smooth muscle actin and desmin. Liver metastasis was noted at 5 months postoperatively, and transarterial embolization was done.