Adult Adrenocortical Carcinoma Mass with Extension into the Inferior Vena Cava and Cushingoid Features: a Rare Case with Review of Literature

Adrenocortical carcinoma (ACC) is an uncommon disease that accounts for only 0.02% of all cancers. Herein, we report a case of adult ACC with extension into the inferior vena cava and Cushingoid features. A 67-year-old woman was admitted to the surgery service for surgical resection of adrenal mass which was found on hypertension work-up. On physical examination, she was obese and cushingoid with ecchymoses on her skin. The patient was hypokalemic at the time of admission. Spiral CT with contrast of the abdomen and pelvis was done and showed solid mass measuring 10x11 cm, superior to the right kidney and posterior to IVC (inferior vena cava) with anterior displacement of IVC. Microscopic diagnosis was adrenocortical carcinoma with vascular invasion and necrosis (20% of surface area). In conclusion, hypertension can be the most common complaint in ACC patients and the presence of both hypertension and hypokalemia in a case can probably increase suspicion of ACC. Future studies are required to address these complaints.