A 58-year-old woman, who was studied by the gastroenterology service for pain in the right hypochondrium for 6 months, accompanied by changes in bowel habits.
There is no general syndrome or urological clinic.
Physical examination revealed good general condition, normohydrated and normal color and moderate obesity.
Cumulative colitis and virilization stigma are not present.
Blood pressure values are normal.
Cardiopulmonary auscultation is normal.
The abdomen is globuleous, blando and depressible, making difficult the fixation of possible masses or organomegaly, showing mild pain at deep pressure in the right hypochondrium, without Mur's sign.
As for complementary examinations, routine biochemical and hematological analysis, as well as adrenal function tests are within normal ranges.
Ultrasound showed a tumor in the right adrenal area of approximately 6x6 cm. No liver metastases were observed.
The CT confirms the mass referred, in close contact with the inferior vena cava wall that apparently cannot be ruled out displaced.
There is no evidence of retroperitoneal lymph node involvement or metastasis at another level.
There was also no evidence of tumor thrombosis.
These findings are consistent with the practice of a correct definition of tissue involvement, reporting identical TAC findings and not being able to definitively predict the parietal stenosis.
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With the diagnosis of adrenal mass an intervention was decided, which is carried out through a right subcostal transperitoneal incision.
The right region is approached and an adrenal mass is diagnosed.
Dissection of the vena cava was initiated and no separation plane was found in the contact zone with the lateral and posterior wall of the vena cava, so it was decided to perform excision of the vena cava after venous control and distal suture of the vena cava.
The patient has a favorable postoperative course without developing complications.
She's discharged on the seventh day post-intervention.
The macroscopic histological study showed a 6 x 8 cm piece of elastic consistency and easy cut, with a fleshy appearance and brownish-gray coloration.
Adrenocortical remnants are recognized in the periphery, with apparently normal appearance.
Signaling in the walls refers to a proliferation of stromal cell line, with large pleomorphic nuclei, with multinucleated cells that adopt a fascicular pattern.
The mitotic index is high (7 m/ 10 high-power fields).
There are areas of intratumoral necrosis and invasion of adrenal tissue present in the peripheral area.
The definitive diagnosis is CAVA LEIOMIOSARCOMA.
As for the evolution, both analytical and imaging controls performed in the early postoperative period showed normal results.
We report a case of consolidation treated with radiotherapy in the emergency department, starting 40 days after surgery.
New controls were performed at 6, 9, 12 and 24 months, all of them normal.
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The patient is currently alive and disease-free after 28 months of follow-up.
