Adrenal Tumors with Venous Thrombosis: A Single-Institution Experience

Objective: To assess the incidence, imaging, surgical approach and prognosis of adrenal tumors associated with venous thrombosis. Material and Methods: Charts of 206 patients who underwent adrenal surgery were reviewed. Data of patients with pathologically confirmed venous thrombosis, utilized diagnostic modalities, operative treatment and prognosis were reviewed and analyzed. Results: Venous thrombosis was confirmed pathologically in 6 patients (2.9%). All were of male gender with age ranging between 2 and 54 years. The mean size of the masses was 11.5 ± 5.2 cm. Venous thrombosis was diagnosed preoperatively in 2 patients, adrenal vein thrombosis in 1 patient, and renal vein thrombosis in the others. Masses were successfully excised via an open approach in association with nephrectomy in 3 cases. There was no operative mortality or gross morbidity. Pathologically, thrombosis was limited to the adrenal vein in 4 patients and extended to the renal vein in 2. Pathology of the masses revealed neuroblastoma in 2, pheochromocytoma in 2, adrenocortical carcinoma in 1, and pleomorphic sarcoma in 1 case. Metastasis developed within 6 months in 3 of these patients. Conclusion: Venous thrombosis with adrenal tumors is a rare pathological condition in which open surgery is the standard of care. Primary malignant adrenal masses with venous thrombosis have a poor prognostic outcome.